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Anes& Coex > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

(52 cards)

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1
Q

SLE pt presents w what on dx

A

Antinuclear antibodies, rash, low plt ct, serositis, nephritis

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2
Q

SLE: occurs mostly in who, can be induced by what

A

Young women. Drugs: hydralazine, procainamide, isonizid, methyldopa, slow acetylators at inc risk

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3
Q

What SLE inflammation and vasculitis does

A

Vessel wall thickening, weakening, narrowing, and scarring: CAD, Stroke risk etc. HTN, pulmonary HTN, Thromboembolism, Hypercoagulable state

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4
Q

SLE how skin and membranes affected

A

Butterfly rash, nasal erythema, oral and pharyngeal ulcers

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5
Q

How joints and muscle affected by SLE

A

Symmetrical arthritis, cricoarytenoid arthritis, myopathy, tendon rupture

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6
Q

How lungs affected by SLE

A

Lupus pna, restrictive, atelectasis (phrenic nerve neuropathy)

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7
Q

How kidneys and heart affected by SLE

A

Glomerulonephritis leading to nephrotic syndrome and RF. Pericarditis and valvular disease

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8
Q

How CNS and liver affected by SDLE

A

Cognitive symptoms, biliary cirrhosis, autoimmune hepatitis

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9
Q

SLE tx: mild

A

NSAIDs, low dose steroids, hydroxychloroquine for skin and arthritis

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10
Q

Severe SLE tx

A

High dose steroids (stress dose intraop), methotrexate

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11
Q

Stress dosing for small,m moderate, or major surgery

A

None. 25 mg hydrocortisone q8 then taper 1-2 days. Major 50 mg q8 then taper 2-3 days

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12
Q

Anesthesia consid w airway management SLE

A

Laryngeal erythema and edema common, CA arthritis, ulcers, laryngeal nerve Palau

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13
Q

Consid for regional SLE

A

Coagulopathy or on anticoagulants. May have nerve lesion

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14
Q

How SLE affects anesthesia drug choices

A

Which SLE drugs on, if renal imp, hepatic clearance, cardiopulm involvement.

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15
Q

SLE drugs for altered renal function

A

Propofol and etomidate good. Benzos prolonged, urine elim. Opioids- demerol and morphine metabolites, resp dep in RF. VA ideal d/t no dep on renal elim

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16
Q

Where early RA appears

A

Hands, wrists, ankles, feet

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17
Q

Where late RA appears

A

Knees, elbows, shoulders

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18
Q

RA fx on lung and heart

A

Effusions, pulm fibrosis (restrictive pattern), pericarditis, tamponade, coronary arteritis, aortic insufficiency, dysrhythmias from nodes

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19
Q

RA drugs to tx RA

A

DMARDS slow progression. Methotrexate, axothioprine, sulfasalazine, TNF inhibitors/monoclonal antibodies

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20
Q

RA document what pre op.

A

ROM limits, baseline pain, numbness, weakness

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21
Q

RA airway consid/management

Study These Flashcards
A

Assess TMJ. If ltd and cervical spine immobile may do awake fiberoptic. Cricoarytenoid- hoarseness, can make glottic opening stenotic, smaller tube size, edema can lead to obstruc postop

22
Q

RA atlantoaxial subluxation: what it is, interferes w what

Study These Flashcards
A

Anterior arch of atlas to odontoid process, >3 mm. Risk of SC/medulla compression, interferes w vertebral artery flow.

23
Q

RA atlantoaxial subluxation: how to handle

Study These Flashcards
A

Determine awake head positions tolerated. Ask about tingling in hands, feet, pain, ROM. Avoid excessive movements w laryngoscopy

24
Q

Where OA occurs

Study These Flashcards
A

Middle/lower cervical spine and lower lumbar. Weight bearing joints (hips, fingers, knees, feet)

25
OA anesthesia consid
Positioning, support to joints. Dont need to give steroids. Bleeding potential from asa and nsaids
26
Complication from joint surgery in OA
Bone cement can cause fat and marrow embolisms (implantation syndrome). Hypoxia, hypotension, dysrhythmias, pulm htn, dec CO
27
OA complic from pneumatic tourniquets
Prolonged inflation can cause pain and nerve damage. Dont overdo opioids. Deflation- hemodynamic changes and washout of metabolic wastes
28
MG clinical features
Ptosis, diploplia, bulbar involvement (aspiration), myocarditis (afib,hb), proximal muscle weakness (neck, shoulders, resp muscles)
29
How MG drugs effect our drugs
On cholinesterase inhib. Prolonged sux, mivacurium, ester LAs
30
MG. What can enhance weakness. Med consid
Aminoglycosides. Propofol (short acting). Maybe no NMB, lidocaine to a/w. RSI if aspiration risk, give sux but may be prolonged
31
MG maintenance
Deep w VA, enough relaxation
32
MG emergence
Greater risk postop RF. Awake w ETT in. Head lift 5 sec. clos obs
33
Myasthenia syndrome clinical features
Proximal muscle weakness, bottom to top. Can affect resp muscles. Autonomic dysfunc: hemodynamic variability
34
Myasthenia syndrome anesthesia consid
Sensitive to all NMBs. Anticholinesterase drugs may not reverse them. VA alone may provide enough relaxation. Small doses NMBs
35
DMD CM
Hyphoscoliosis, weakness and contracture. Muscle weakness in proximal extrem. Degen of heart muscle, dec ability to cough, resp muscle weakness, delayed gastric emptying (aspiration risk)
36
MD cardiac abn
Atrial arrythmia, prolonged PR, dec myo contractility and cardiomyopathy, mitral regurg
37
MD resp fx
Weakness, infections, restrictive pattern, pulm htn
38
MD anesthesia consid
Heart and lung involvement. Avoid pre op meds d/t aspir risk. Premed w GI meds, maybe glyco too for secretions. Positioning
39
MD infduction: what is contraindicated
Sux, unpredictable. Risk of hyperkalemia, rhabdo, cv arrest, MH
40
MD maintenance. What is preferable
Cardiopulm depression w VA, prolonged response to NMB. Regional
41
Marfans CM
Long tubular bones, hyperextensible joints, high arched palate, crowded teeth, pectus excavating, kyphoscoliosis
42
Marfans CV fx
Aortic aneurysm and dissection, AV valves affected, MV prolapse, BBB, aortic and aV valve calcification
43
Marfans lung involvement
Pectus excavating/scoliosis, restrictive pattern. Dec compliance, inc PVR nad pulm htn
44
Marfans tx
BB to reduce heart workload. Aortic repair, spinal fusion
45
Marfans anesthesia consid preop and a/w
Cardiac abn focus on preop. Rarely hard laryngoscopy. TMJ dislocation, do assessment. Tracheomalacia (floppy- can collapse)
46
Marfans: prevent what intra op, do what
Prevent sudden inc contractility, avoid catecholamines, tx hypertension. VAs good
47
Ankylosing spondylitis airway consid
Difficult intub d/t cervical spine and TMJ involvement. Risk of neuro injury w neck extension. Kyphosis limits intub. Cricoarytenoid arthritis
48
Akylosing spondylitis cv involv
Aortic regurg (avoid sudden inc SVR, keep HR <90, low normal BP), BBB, cardiomegaly
49
Ankylosing spondylitis pulm abn
Fibrosis, apical cavity lesions, pleural thickening (like TB), dec compliance of chest, dec VC
50
Ankylosing spondylitis anesthesia consid
Restrictive disease, a/w involvement, may do awake fiberoptic intub. Epidurals are difficult, do paramedical
51
Achondroplasia anesthesia consid
Difficult IV and CVL placement, pulm htn common, restrictive vent, OSA common, upper a/w obstruc
52
Achondroplasia airway management consid
May be difficult mask, larynx may be small (hard to expose glottis, base on weight rather than age). Avoid hyperextension

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