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COEXISTING 2 Exam 2 > Skin Disorders > Flashcards

Skin Disorders Flashcards

1
Q

Bullae

A

large blisters on skin filled with clear fluid

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2
Q

Hemorrhage from ruptured oral bullae has been treated successfully by what

A

epi soaked gauze directly to bullae

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3
Q

can you use tape with bullae

A

no

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4
Q

scleroderma

A

inflammation and autoimmunity, vascular injury with eventual vascular obliteration, and fibrosis accumulation of XS matrix in many organs and tissues

Tissue fibrosis and organ sclerosis, widespread capillary loss and vascular obliteration and leakage of serum proteins into the interstitial space

Often see CREST syndrome

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5
Q

onset of scleroderma

A

20-40yrs (women)

pregnancy accelerates about half of patients

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6
Q

CREST syndrome

A 
Calcinosis 
Raynauds 
Esophageal dysfunction 
sclerodactyly 
telangiectasia
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7
Q

calcinosis

A

painful lumps of calcium in the skin

fingers, body

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8
Q

raynauds phenomenon

A

white or cold skin on the hands and feet when you’re cold or stressed. caused by BF problems.
Absence of BF due to vasoconstriction

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9
Q

esophageal dysfunction

A

problems swallowing/reflux

caused by scarring in the esophagus

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10
Q

sclerodactyly

A

tightness and thickening of finger or toe skin. can be hard to bend

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11
Q

telangiectasia

A

red spots on hands, palms, forearms, face, and lips. caused by widened blood vessels

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12
Q

signs and symptoms of scleroderma

CV, renal, GI

A

predisposed to corneal abrasions lube eyes

Replace cardiac muscle with fibrous tissue = dysrhythmias, conduction abnormalities, CHF
-Pulm HTN –> cor pulmonale
Arterial hypoxemia

renal artery stenosis and decreased RBF

fibrosis GI tract - hypomotility of lower esophagus and SI

dysphagia = LES tone decreased, increased reflux

malabsorption syndrome/coagulation disorders

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13
Q

10-15% of people who develop a scleroderma renal crisis can be treated effectively with what?

A

ACEi

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14
Q

xerostomia

A

dryness oral mucosa

seen in scleroderma

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15
Q

what is good with treating malabsorption syndrome/vitK

A

broad spectrum ABx

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16
Q

scleroderma anesthesia management

A

fiberoptic intubation
no NPA or OPA (nasal and oral mucosa bleed easy)
IV access impaired by dermal thickening
avoid increase in PVR (respiratory acidosis, arterial hypoxemia)
sensitive to respiratory depressant opioids

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17
Q

Marfan syndrome

A 
long, tubular bones (Abe) 
high-arched palate
emphysema 
spont pneumo 
aortic dilation, dissection or rupture and prolapse the cardiac valves, esp mitral 
pregnancy triggers dissection 
BBB = common
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18
Q

What is common in Marfan syndrome and what is a prophylactic therapy

A

BBB and prophylactic BB therapy

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19
Q

anesthesia considerations marfan syndrome

A

focus on cardiopulmonary
abnormalities

AVOID any sustained increase in BP (risk aortic dissection). this includes DL or painful surgical stim

invasive monitoring good option (ex TEE)

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20
Q

Ehlers Danlos Syndrome

A

inherited CT disorder caused by abnormal production of pro collagen and collagen

joint hypermobility, skin fragility, hyper elasticity, bruising and scarring, musculoskeletal discomfort, osteoarthritis

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21
Q

What is the form of Ehlers Danlos Syndrome associated with an increased risk of death

A

vascular type

-complicated by rupture of large blood vessels, the bowel, and uterus

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22
Q

Common issues with Ehlers Danlos

A

Dilation of trachea and higher incidence of pnemo. Use a bigger ETT and keep cuff pressures down to minimize bleeding

23
Q

Management Anesthesia Ehlers Danlos

A 
avoid IM 
avoid anything in nose 
gentle during DL 
a-line and c-line can cause hematoma 
maintain low airway pressure during assisted or controlled mechanical ventilation otherwise pneumothorax 
don't do regional
24
Q

Pseudohypertrophic Muscular Dystrophy (Duchenne Muscular Dystrophy)

A

muscles more weak and flexible over time
stiff joints

DMD most common type

almost always affects boys and Sx begin in childhood

also degenerates cardiac muscle

25
Q

ECG of Duchenne Muscular Dystrophy

A

tall R waves in V1
Deep Q waves in limb leads
Short PR
sinus tachycardia

26
Q

pseudotrophy

A

muscle tissue eventually replaced by fat and CT

lose ability to walk by 12

27
Q

Management anesthesia for DMD

A

always full stomach
use of Six is contraindicated because risk hyperK, rhabdomyolysis, CA
normal response to NDMBs
rhabdomyo has been noted with volatile agents even without use of sux
dantrolene should be available (increased MH)

28
Q

Duchenne think what?

A

Dantrolene!

29
Q

management anesthesia if you hear “myopathy”

A 
micrognathia and a high arched palate = difficult intubation 
resp muscle weakness 
v/q mismatch 
much higher CO2 to trigger response 
unpredictable response to sux and NDMBs 
myocardial depression
30
Q

Kearns Sayre syndrome mitochondrial myopathy

A

mitochondrial myopathy
skeletal muscle energy metabolism disorder
abnormal fatigue
•Progressive external ophthalmoplegia, retinitis pigmentosa, heart block, hearing loss, short stature, peripheral neuropathy, and impaired ventilatory drive
•Dilated cardiomyopathy and congestive heart failure may be present.

31
Q

Kearns Sayre syndrome anesthesia management

A

drug induced myocardial depression risk
development of cardiac conduction defects
hypoventilation

32
Q

alcoholic myopathy
floppy infant syndrome
anesthesia

A

increased sensitivity to NDMBs
Sux: hyperK and CA
ketamine can be useful

33
Q

myopathy, think of what?

A

MR and K

34
Q

what is the most common NMJ disease

A

Myasthenia Gravis

35
Q

myasthenia gravis

A

decrease in final ACH receptors at NMJ resulting from destruction or inactivation by circulating antibodies
can loose up to 80% of functional receptors
women 20-30 most affected
eye deviation and drooping eyelid

36
Q

anesthesia for MG

A

sensitive to ND MR
use small doses of Roc start with 1/5 the dose (decreased number of functional ACH-R)

patients treated with pyridostigmine demonstrate resistance to sux

induce with short acting agent

don’t need MR to intubate usually - weak

oMonitoring these responses at the orbicularis oculi muscle may over-estimate the degree of neuromuscular blockade but may help to avoid unrecognized persistent neuromuscular blockade in these patients

37
Q

classifications of MG (5 types)

A 
T1 = extraocular muscles 
T2a= slowly progressive, mild sk. m. weakness that spares respiration muscles
T2b = rapidly progressive, more severe form and may involve respiratory muscles 
T3 = acute onset and rapid deterioration of sk m strength within 6mo 
T4 = severe form that results from progression of T1 or T2 MG
38
Q

if a patient has thymomas, what is likely

A

MG

seen in 10% of MG pts

39
Q

what drug causes a resistance to sux

A

pyridostigmine

40
Q

what muscle may overestimate the degree of NM blockade

A

orbicularis oculi

41
Q

myasthenia syndrome

A

from a carcinoma in the lung
skeletal muscle weakness with a small cell carcinoma in the lung
•IV immunoglobulin, plasmapheresis, immunosuppressive therapy, and treatment of the underlying cancer can all cause improvement in this condition.
•Eaton-Lambert syndrome resembles myasthenia gravis

42
Q

myasthenia syndrome anesthesia

A

sensitive to NDMB and SUX

antagonism of NMB with anti cholinesterase may not work

43
Q

osteoarthritis

A

most common joint disease
degenerative process that affects articular cartilage
knees and hips common

44
Q

kyphoscoliosis

A

spinal deformity anterior flexion (kyphosis) and lateral curvature (scoliosis) of vertebral column
ANT and LAT
begins in late childhood
females 4x more

45
Q

kyphoscoliosis management anesthesia

A

ABG, PFT
assess restrictive lung disease
ABG: hypoxemia? acidosis? pulm HTN
often have pulmonary infon from chronic aspiration

•Nitrous oxide may increase pulmonary vascular resistance leading to pulmonary hypertension

46
Q

Rheumatoid arthritis

A

most common inflammatory arthritis
1% of adults
•Diagnosis is primarily clinical and notable for morning stiffness and metacarpophalangeal involvement (unlike OA which affects the distal interphalangeals)

•Nearly every joint is affected except for the thoracic and lumbosacral spine.
•Cervical spine involvement is frequent and can result in pain and neurologic complications
oRange of neck motion should always be evaluated preoperatively by asking the patient to demonstrate head movement or positioning.
NARROWED GLOTTIS

47
Q

what drugs are RA patients often on

A

NSAIDs and or glucocorticoids

oThe effect of aspirin or NSAIDs on platelet function must be considered. Corticosteroid supplementation may be indicated in patients being treated long term with these drugs.

48
Q

Anesthesia for RA

A

airway - look for atlantoaxial subluxation
•When atlantoaxial subluxation is present, care must be taken to minimize movement of the head and neck during direct laryngoscopy to avoid further displacement of the odontoid process and damage to the brainstem or spinal cord
oMinimal movement of neck!!

Narrowed glottis
fiberoptic intubation

49
Q

why is atlantoaxial subluxation bad and important to look for with RA

A

This abnormality is important because the displaced odontoid process can compress the cervical spinal cord or medulla or occlude the vertebral arteries

50
Q

systemic lupus erythematosis anesthesia

A 
•Assess magnitude of organ system dysfunction and the drugs used to treat SLE
oSteroids
oNSAIDS
oASA
oAntimalarial drugs
•Laryngeal involvement
omucosal ulceration
ocricoarytenoid arthritis
orecurrent laryngeal nerve palsy
omay be present in 1/3 of patients
51
Q

ankylosing spondylitis considerations

A

stiff neck - Spinal column can be stiff and deformed and prevent appropriate cervical spine motion for endotracheal intubation

•Aortic regurgitation - keep the heart rate at 90 beats per minute or higher and the systemic vascular resistance lower than normal
o Sweeping water off porch = fast helps = >90bpm HR

52
Q

What does the presence of HLA-B27 mean

A

genetic marker that have inflammatory arthritis of spine and joints (not osteoarthritis)
associated with seronegative spondyloarthropathies

53
Q

seronegative spondyloarthropathies

A

+ HLAB27
ankylosing spondylitis (AS), psoriatic arthritis, and Reiter’s syndrome (also called reactive arthritis)
•HLA-B27 is present in about 90% of people with AS, but the gene can also be seen in people with no sign of arthritis or inflammation.

54
Q

dwarfism 2 forms

A

proportionate

disproportionate (limited bone development)

COEXISTING 2 Exam 2 (2 decks)

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