Test 3 Part 2 Flashcards by Brandon Edmondson

what is CREST syndrome and what dz is it affiliated with?

calcinosis
raynauds
esophogeal dysmotility
sclerodactyly
telangiectasia

limited cutaneous systemic sclerosis

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which type of scleroderma is characterized as a rapidly progressive dz with generalized skin involvement and CV complications like CAD, cardiomyopathy, and HTN?

diffuse cutaneous sclerosis

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__________________ sclerosis is rare and has the classic internal organ presentation without cutaneous manifestation

systemic

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complications/concerns with systemic sclerosis

chronic renal failure in > 50% of pts
polymyositis (muscle pain)
raynauds (>95%)
tightening of skin around mouth/fibrosis limits neck extension (airway)
Sjogren syndrome
Difficult IV access
Contractures: positioning concerns

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difficult IV access is a hallmark of _______________

scleroderma

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H&P for pt with scleroderma

type/onset and sx
airway examination
CV and pulm : myocardial and pulm fibrosis
GI prophylaxis r/t poor gastric emptying
Raynauds
evaluate other organ involvement esp kidney
extremities for IV access
Current meds and Side effects

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pts with scleroderma may need GI prophylaxis due to…

decreased GI motility –> frequent episodes of gastric reflux which increases risk of aspiration pneumonitis

decreased Small intestine and colonic motility can –> pseudo obstruction

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when would you consider CBC for pt with scleroderma?

if on immunosuppresants

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when would you consider ordering a PT & albumin level for pt with scleroderma

if appear malnourished

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what labs would you consider for pt with scleroderma?

CBC
PT and albumin
BUN/Cr
electrolytes

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if a patient with scleroderma presents and during the H&P they state that their sx include extreme muscle pain, what lab would you consider?

Cr phosphokinase (CPK)

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what preop meds should the patient with scleroderma be taking prior to surgery to treat Raynauds symptoms? and should they be continued DOS?

calcium channel blockers; yes

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what preop meds should the pt with scleroderma be on prior to surgery for renal protection? should they be taken DOS?

ACEI/ARB ; NO

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pts with scleroderma should be on a _______________ for reflux prior to surgery; if not you should ______________.

PPI; GI prophylax

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preop pulmonary meds for pt with scleroderma d/t severe pulmonary HTN

prostacyclins or phosphodiesterase inhibitors, O2,

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what preop CV meds should pt with scleroderma be on/considered ?

digoxin (improve CO)
diuretics
anticoags

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when should a pt with scleroderma be on a immunosuppressant preoperatively?

for severe or worsening cutaneous sx, lung, cardiac, and muscle involvement but with limited success

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pt with scleroderma what meds/tx are continued throughout the perioperative period?

antireflux
vasospasm
pulmonary HTN

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anesthetic considerations for pt with scleroderma

difficult venous access
keep warm to prevent reynauds flare up
consider videolaryngoscope or FOB
aspiration prophylaxis
regional anesthesia
avoid depressant anesthetics
intraoperative monitoring determined by comorbid dx of pulmonary htn or cardiac fibrosis

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T/F: you should consider nasal intubation in pt with scleroderma

false; AVOID nasal intubation

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T/F: A-line should be placed in pt with scleroderma undergoing surgery

false; Aline placement carries higher than usual risk d/t already poor circulation

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_____________ is 3x more common in pts with scleroderma; therefore, appropriate prophylaxis necessary

VTE

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__________________ is the degeneration of the articular cartilage characterized by inflammation and pain with joint motion

osteoarthritis

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what is the difference between RA and OA

no systemic manifestations with OA

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what joints are commonly involved with RA?

fingers, hands, wrists, knee, ankle, toes TMJ, sternoclavicular, shoulder, elbow, and hip can also be involved (less common)

what joints are commonly involved with OA

distal fingers, thumb-wrist joint, hip, knee, big toe proximal IPJ can also be involved (less common)

_______________ is the most common form of arthritis in the US secondary to aging population and obesity

what is the leading cause of lower extremity disability

on the kellgren-Lawrence grading system of OA, on a scaled of ____ - ____; definite radiographic OA is defined as KL grade of ________ or higher

0;4;2

OA is defined radiographically through the _______________________

Kellgren-Lawrence Grading severity of OA 0-4

Pathologically OA is defined/characterized by?

cartilage loss osteophytes subchondral bone marrow lesions and bone attrition meniscal lesions (knees) synovitis and effusion

clinically OA is defined/characterized by?

pain on weight bearing activity at the early stages, with progression to more persistent pain as well as fx'al limitations and disability

how do you manage OA?

1. wt loss 2. exercise 3. physiotherapy 4. bracing in certain areas 5. tylenol and NSAIDs 6. opoids 7. Local injections +/- corticosteroids 8. Viscosupplmentation (hyaluronic acid) 9. surgery

for OA, joint replacement is typically performed as last option in the late stages with outcome for _____________ being better than for _____________

hip; knee

H & P for pt with OA

1. what joints are involved? C-spine? 2. Routine Review of Systems 3. Chronic pain? if so what meds? 4. neuro assessment for sensory/motor deficits

do you typically have issues with intubation (r/t C-spine) in pts with OA?

not typically; may have issues if are obese or have other comorbidities

Preop Testing for pt with OA

1. no specific testing r/t OA 2. may do testing related meds 3. Evaluate functional capacity - activity limited by joint pain?

if pt is on herbal medications like ginko to help their OA. It should be recommended to be stopped _________ days prior to surgery

anesthesia consideration for pt with OA

1. if have pain in C-spine with flexion --> intubate in neutral position use videolaryngoscope/FOB 2. regional considerations: can you acutally perform the block and it work appropriately?

most cases of kyphoscoliosis are idopathic, with it classically presenting in ____________________

adolescent males

pt may have 2ndary kyphoscoliosis d/t underlying ___________________

neuromuscular dz

when is kyphoscoliosis consider pathologic?

if anterior curvature of any region of the spine is > 45 degrees

_______________ is lateral curvature of the spine, and is frequently found with ____________

scoliosis ; kyphosis

T/F: kyphosis is often isolated

true

dx and severity of kyphoscolosis is based on the measurement of the ______________

cobb angle

kyphoscoliosis can be associated with severe __________________________

restrictive pulmonary dz

_______________ and _______________ may induce spinal cord damage bc of the sharp angulation of the spine

kyphosis ; kyphoscoliosis

what treatment for kyphosis/kyphoscoliosis is indicated to prevent long term ventilatory compromise, restrictive lung disease, and cardiopulmonary sequelae

surgery

surgery for kyphoscoliosis is usually indicated with scoliosis curvature exceeding ____________ degrees

T/F: majority of cases of Kyphoscoliosis are idiopathic presenting during childhood

true

for kyphoscoliosis males are affected __________ more than females

what is the minimum cobb angle to define scoliosis

10 degrees

cobb angle (scoliosis) of 15 - 20 degrees

no treatment, regular check ups to see if curve is progressing up until bone maturity. possible PT

at what cobb angle with scoliosis will a dr generally prescribe a back brace to keep the spine from developing more of a curve?

between 20 and 30

at what cobb angle (scoliosis) may surgery (spinal fusion) be required to correct the curve?

40-50

H & P for kyphoscoliosis

1. age of onset and curvature 2. can pt lie flat for intubation? 3. detailed plan for difficult intubation 4. look for increased WOB, cyanosis, hypoventilation, asymmetric chest expansion, pectus excavatum 5. fx'al status, level of exercise

what are disease states associated with kyphoscoliosis?

1. neurofibromatosis 2. ependymoma, astrocytoma 3. cerebral palsy 4. poliomyelitis 5. muscular dystrophy 6. freidrich ataxia 7. marfan syndrome 8. collagen vascular disorders

________________ is a disease state associated with kyphoscoliosis, it is a tumor that arises from a tissue of the central nervous system

ependymoma

in peds the location of an ependymoma is ______________, while in adults it is ______________

intracranial; spinal

what is the most common location of an intracranial ependymoma

fourth ventricle