Skin & Musculoskeletal Diseases Flashcards by Alyssa Rivera

Acanthosis nigricans and atopic dermatitis

Rashes

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How are epidermolysis, pemphigus, and mastocytosis all treated?

Steroids

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Profound hypotension with radiocontrast media

Mastocytosis

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What is worsened by various elements of anesthetic management?

Weeping skin lesions and/or risk of generalized infection

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How is mastocytosis pretreated?

H1 and H2 histamine receptor antagonists and a glucocorticoid before procedure involving contrast dye

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4 main things with skin diseases?

Avoid histamine release
Warm cold drugs before injection
Warm IV fluids and increase temp of OR
H1 and H2 receptor antagonists and corticosteroids

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Large blisters on the skin that are filled with clear fluid

Bullae

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Bullae formation can be caused by (5)

Trauma from: tape, BP cuff, tourniquet, adhesive electrodes, alcohol wipes

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Chronic scarring of the oral cavity from bullae can result in what?

Narrow oral aperture and immobility of the tongue

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Which bullae has not been reported?

Tracheal bullae

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Anesthesia management with bullae?

Anything that touches pt should be well padded

Trauma from: tape, BP cuff, tourniquet, adhesive electrodes, alcohol wipes

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Bullae and airway?

Treat gently

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Hemorrhage from ruptured oral bullae can be treated with what?

Epi soaked gauze

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Intubation and bullae?

Tube must be carefully immobilized with soft cloth bandages

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

Scleroderma

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What can trigger scleroderma (3)

Toxins, drugs, and some microbial pathogens

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Age scleroderma typically onsets

20-40, women

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What can you get with scleroderma?

CREST syndrome

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What does CREST syndrome stand for?

C: calcinosis 
R: Raynaud’s phenomenon 
E: esophageal dysfunction 
S: sclerodactyly
T: telangiectasia

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White or cold skin on the hands and feet when you’re cold or stressed. It’s caused by BF problems.

Raynaud’s phenomenon

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Tightness and thickening of finger or toe skin. Can be hard to bend fingers

Sclerodactyly

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Red spots on hands, palms, forearms, face, and lips. Cause by widened blood vessels.

Telangiectasia

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Scleroderma may predispose to?

Corneal abrasions

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What does scleroderma affect? (7)

Skin and musculoskeletal system, NS, CVS, lungs, kidneys, and GI tract

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Scleroderma and lungs?

Pulmonary HTN, may require higher airway pressures, and avoid increase PVR

Scleroderma and opioids?

Sensitive to respiratory depressant effects

Long tubular bones, giving them a tall stature and “Abe Lincoln” appearance

Marfan syndrome

Marfan syndrome and lungs (2)

Emphysema and pneumothorax

Marfan syndrome and CV? (5)

1. Aortic dilation 2. Aortic dissection 3. Aortic rupture 4. Prolapse of valves (mitral) 5. BBB

What kind of therapy is common for Marfan syndrome?

Prophylactic BB

Marfan syndrome and pregnancy?

Rupture and dissection of aorta

Why kind of minoring is needed for Marfan syndrome?

Invasive monitor: Transesophageal echocardiography

Inherited connective tissue disorders caused by abnormal production of pro collagen and collagen

Ehlers-danlos syndrome

Ehlers-danlos syndrome and blood vessels, bowel, uterus?

Can be ruptured

S/s of ehlers- danlos syndrome? (5)

1. Joint hyper mobility 2. Skin fragility or hyper elasticity 3. Bruising and scarring 4. Musculoskeletal discomfort 5. Susceptibility to osteoarthritis

What should be avoided with anesthesia and ehlers-danlos syndrome? (2)

1. IM injections/instrumentation of nose or esophagus | 2. Regional

ECG of muscular dystrophy (4)

1. Tall R in V1 2. Deep Q waves in limb leads 3. Short PR interval 4. Sinus tachycardia

Muscular dystrophy’s muscle tissue eventually replaced by?

Fat and connective tissue; pseudo hypertrophy

Pseudohypertrophic (enlarging) of what 2 things?

Tongue and calf muscles

Can you use sux for muscular dystrophy?

NO bc risk of rhabdomyolysis, hyperkalemia, and/or cardiac arrest

What has an increased incidence with muscular dystrophy?

MH so have dantrolene available

7 inherited myopathies:

1. Nemaline rod myopathy 2. Myotonia congenital 3. Paramyotonia congential 4. Periodic paralysis 5. Central core disease 6. Multi core myopathy 7. Centronuclear myopathy

Myopathies sux and NMDR effects?

Unpredictable

Group of disorders of skeletal muscle energy metabolism; defects result in abnormal fatigability with sustained exercise, skeletal muscle pain, and progressive weakness

Mitochondrial myopathies (kearns-sayre syndrome)

Mitochondrial myopathies (kearns-sayre syndrome) and GA? (3)

1. Drug induced myocardial depression 2. Develop cardiac conduction defects 3. Hypoventilation during early post op

Alcoholic myopathy/ floppy infant syndrome effect with managing anesthesia? (3)

1. NDMR increased sensitivity and sux can cause hyperkalemia 2. Infants risk MH 3. Ketamine does not cause significant respiratory

What do you think of when you see myopathies?

Muscle relaxants and K+

Most common disease affecting NMJ; decrease in functional ACh receptors at NMJ resulting from their destruction or inactivation by circulating antibodies

Myasthenia gravis

MG and eye problem?

Deviation and dropping eyelid

Limited to involvement of extraocular muscles (10% pts)

Type 1 MG

Slowly progressive, mild form of skeletal muscle weakness that spares muscles of respiration (respond to anti cholinesterase drugs and corticosteroids)

Type 2a MG

More rapidly progressive and more severe form of skeletal muscle weakness (respond to drug therapy is not as good, respiration muscles may be involved)

Type 2b MG

Acute onset and rapid deterioration of skeletal muscle strength within 6mths (high mortality rate)

Type 3 MG

Severe form of skeletal muscle weakness that results from progression of type 1 or 2

type 4 MG

Chest X-ray and ct scan to evaluate their need to remove thymus and any cancerous tissue that may be present and how often is this seen in MG pts?

Thymomas; 10%

If surgery is performed to remove thymoma, does it lead to remission of MG?

MG and intubation?

Can be accomplished without NMB bc of intrinsic muscle weakness and relaxant effect of volatile anesthetics on skeletal muscle

Skeletal muscle weakness usually with small cell carcinoma of lung; this deficiency restricts Ca++ entry when terminal is depolarized

Myasthenic syndrome

What other syndrome resembles MG?

Eaton-lambert syndrome

Myasthenic syndrome and muscle relaxants

Sensitive to both NDMR and DMR; anticholintesterase drugs may be inadequate; so decrease doses of muscle relaxants

Most common joint disease, degenerative process that affects articular cartilage; most common in knees and hips

Osteoarthritis

Anterior flexion of spine

Kyphoscholiosis

Pulmonary function and skeletal disease?

Restrictive lung disease

Most common inflammatory arthritis; morning stiffness and metacarpophalangeal involvement

Rheumatoid arthritis

Pts will be on what drugs for rheumatoid arthritis?

NSAIDs and/or glucocorticoids

What joints are affected with rheumatoid arthritis?

Every joint except thoracic and lumbosacral spine

Rheumatoid arthritis and neck movement?

Atlantoaxial subluxation may be present; minimize movement of head and neck during DL to avoid further displacement of odontoid process and damage to brainstem or spinal cord

Spinal column can be stiff and deformed and prevent appropriate cervical spine motion for endotracheal intubation; restrictive lung disease from costochondral rigidity and flexion

Ankylosing spondylitis

Best approach for spinal and epidural anesthesia?

Para median

What Genetic marker in people with inflammatory arthritis of spine and joints (not osteoarthritis) and is associated with presence of one of a group of diseases called what?

HLA-B27; seronegative spondyloarthropathies

HLA-B27 genetic marker can be seen in what 3 diseases?

1. Ankylosing spondylitis (AS) 2. Psoriatic arthritis 3. Reiter’s syndrome (reactive arthritis)

2 forms of dwarfism?

1. Proportionate | 2. Disproportionate

Marked dilation of trachea and bronchi; walls are abnormally flaccid and may collapse during coughing

Tracheomegaly

Osteogenesis imperfecta has the potential for what?

Additional fractures

Pigeon chest

Pectus carinatum

Inward concavity of sternum

Pectus excavatum

Infrequent but potentially lethal postop complication; Posterior fossa crani performed in sitting Arterial compression Venous compression with neck flexion Head down position Mechanical compression of tongue by teeth, oral airway, ETT

Macroglossia

Skin & Musculoskeletal Diseases Flashcards

(77 cards)