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Brandon’s AFN Health Assessment > Test 3 part 3 > Flashcards

Test 3 part 3 Flashcards

1
Q

_________________ is due to the degeneration of nervous tissue in the spinal cord, particullary with sensory neurons connected with cerebellum. this is often associated with kyphoscoliosis

A

freidreichs ataxia

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2
Q

what laboratory tests may be done for pt with kyphoscoliosis presenting for surgery?

A

CBC, BMP, UA
type and screen

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3
Q

for patients with severe scoliosis presenting for major surgery it is reasonable to consider ___________ and _________ tests

A

PFTs; ABG

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4
Q

anesthesia considerations for pts with kyphoscoliosis

A

1.postop pulmonary complications are common
2. plan for induction
3. monitoring
4. blood optimization (iron, epo)
5. postop care

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5
Q

what monitoring should be considered for pt presenting with kyphoscoliosis

A
  1. a line
  2. neurologic
  3. wake up test
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6
Q

_________________ is a rare autosomal dominate inherited disease of connective tissue that affects bone, sclera, and the inner ear

A

Osteogenesis imperfecta

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7
Q

2 types of osteogenesis imperfecta

A

OI congenita
OI tarda

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8
Q

OI congenita

A

fractures will occur in utero, death occurs during the perinatal period

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9
Q

OI tarda

A

childhood or early adolescence with presence of blue sclera, fractures from trivial trauma, kyphoscoliosis, bowing of femur/tibia, otosclerosis –> deafness

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10
Q

with osteogenesis imperfecta, aside from primary sx, what else may be present?

A

impaired plt fx
hyperthermia with hyperhidrosis
increased serum thyroxine

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11
Q

Tx of OI

A

biphosphonates (strengthen bone)

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12
Q

anesthesia mangement of pt with OI

A
  1. intubation: decreased ROM C-spine, possible mandibular fx
  2. kyphoscoliosis and pectus excavatum –> VQ mismatch
  3. regional anesthesia is acceptable (check plt)
  4. mild intraoperative hyperthermia
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13
Q

in a pt with OI, using _____________, an common induction agent, may lead to fasiculations which may produce fractures

A

succ

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14
Q

_______________ is an inherited autosomal dominant connective tissue d/o that is due to a defect in glyocprotein fibrillin-1

A

marfan syndrome

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15
Q

Clinical features of Marfan syndrome

A
  1. tall stature, long tubular bones (“abe lincoln”)
  2. high arched palate
  3. pectus excavatum or carinatum
  4. kyphoscoliosis
  5. hyperextensibility of the joints
  6. early development of emphysema
  7. high incidence of spontaneous pneumo
  8. ocular d/o
  9. risk of aortic dissection
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16
Q

if have a patient with marfans syndrome, what is the one prudent thing to avoid during surgery?

A

any sustained increase in systemic blood pressure d/t risk of aortic dissection

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17
Q

CV complications in pt with marfan

A

aortic dilation/dissection
prolapsed valves
bacterial endocarditis

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18
Q

for pt with marfan syndrome, they often have what cardiac conduction abnormality

A

BBB

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19
Q

if pt with marfans has a dilated thoracic aorta, what should they be put on prophylactically

A

Beta blocker

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20
Q

_______________ poses a unique risk of aortic rupture/dissection in pts with marfans syndrome

A

pregnancy

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21
Q

anesthesia implications for marfans syndrome

A
  1. focus on CV abnormalities w/ high suspicion for pneumothorax
  2. will have high arched palate –> crowded teeth and TMJ dislocation = airway concern
  3. aortic dissection prevention
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22
Q

__________________ is a group of inherited connective tissue d/o that are caused by abnormal production of procollagen and collagen

A

Ehlers-Danlos syndrome

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23
Q

what type of Ehlers Danlos syndrome may be associated with increased risk of death

A

vascular type

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24
Q

characteristics of Ehlers-Danlos Syndrome

A
  1. joint hypermobility
  2. skin fragility or hyperelasticity
  3. bruising and scarring
  4. musculoskeletal pain - susceptible to OA
  5. GI, uterus, and vasculature have increased type III collagen –> spontaneous rupture
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25
Q

your doing an airway assessment, you ask the patient to open their mouth. you can see the soft palate, fauces, uvula, and the anterior/posterior pillars. What mallampati score would you give this pt?

A

Class I

26
Q

what mallampati classification would you give if you can see soft palate, fauces, uvula, but cannot see the tonsillar pillars?

A

Class II

27
Q

what mallampati score do you give if you can only see the base of the uvula and the hard palate?

A

Class III

28
Q

on assessment, when pt opens their mouth you can only see the hard palate. What mallampati classification is this?

A

Class IV

29
Q

what mallampati score is considered a difficult airway

A

III and IV

30
Q

what is the LEMON airway assessment?

A
  1. Look Externally
  2. Evaluate the 3-3-2 rule
  3. Mallampati score
  4. Obstruction
  5. Neck mobility
31
Q

mouth opening should be how wide?

A

3 finger widths

32
Q

distance from chin to hyoid bone should be ?

A

3 fingers width

33
Q

thyroid cartilage to mouth floor should be how far?

A

2 fingers width

34
Q

what are the 4 Ds that suggest a difficult airway?

A
  1. dentition - prominent upper incisors, receding chin
  2. distortion - edema, blood, vomitus, tumor, infection
  3. disproportion - decreased TMD, large neck, mallampati > 3
  4. dysmobility - TMJ and limited C spine
35
Q

_______________ is a disease characterized by diverse combinations of inflmmation, demyelination + demyelinative plaques, and axonal damage in the CNS

A

multiple sclerosis

36
Q

what is the cause of MS?

A

no clear genetic, environmental, or infectious cause has been identified

37
Q

T/F: pregnancy exacerbates MS

A

false; reduces exacerbations. Postpartum increases risk of relapse

38
Q

this disease is characterized by exacerbations and remissions and unpredictable intervals over several years. Sx persist leading to severe disability from visual failure, ataxia, spastic skM weakness, and urinary incontinence

A

multiple Sclerosis

39
Q

what is the most common type of MS?

A

primary progressing

40
Q

T/F: no treatment is curative for MS

A

true

41
Q

tx for MS

A
  1. corticosteroids
  2. interferon beta
  3. Glatiramer (Copaxone)
  4. Mitoxantrone
  5. Baclofen
  6. Methotrexate
42
Q

what is the prinicpal tx for actue relapses of MS?

A

corticosteroids

43
Q

what is the tx of choice for pts with relapsing-remitting MS?

A

interferon Beta

44
Q

___________________ is a drug used for MS once a patient becomes resistant to interferon beta

A

Glatiramer (Copaxone)

45
Q

what drug for MS is a mixture of randoms synthetic polypeptides synthesized to mimic myelin basic protein

A

Glatiramer (Copaxone)

46
Q

________________ is a drug used for rapidly progressive MS. It is an immunosuppresive drug that fx by inhibiting lymphocyte proliferation

A

Mitoxantrone

47
Q

if pt with MS is on Mitoxantrone, you should be concerned with?

A

cardiotoxicity
subclinical cardiac dysfx

48
Q

_______________ is a drug used for MS that depresses cell mediated and humoral immunity. decreases rate of relapse but no effect on progression of disability

A

Azathioprine

49
Q

if a pt is on baclofen for MS. You should be concerned/aware of

A

prlonged sedation
increased sensitivity to NDMR

50
Q

pts with secondary progressive MS may benefit from tx with _______________

A

methotrexate

51
Q

anesthesia considerations with MS

A
  1. assess and document deficit
  2. consider PFTs if significant respiratory compromise
  3. consider blood testing based on medical management
  4. consider stress dose steroids
  5. take all MS meds up until DOS
  6. AVOID HYPERTHERMIA
  7. AVOID SUCC
  8. judicious NMB
  9. General anesthesia
52
Q

if pt with MS is on steroids and cyclophsphamides for management of the disease; what labs may you consider preoperatively?

A

electrolytes and blood glucose (spec to steroid)

53
Q

if pt is on Terflunomide for MS tx, what lab may you consider preoperatively?

A

LFTs

54
Q

in a pt with MS even an increase in body temp of ____ C, can exacerbate MS

A

1

55
Q

in a pt with MS, what is the most frequently used anesthesia technique d/t no unique interactions btwn MS and drugs with this technique

A

general

56
Q

what anesthetic induction agent do you avoid in a pt with MS

A

succ

57
Q

_________ anesthesia technique has been implicated in posteroperative exacerbations of MS

A

spinal anesthesia block

58
Q

In a pt with MS know that _________________ block are affiliated with postop exacerbations; however, _____________ and ____________ blocks are okay

A

spinal anesthesia; epidural; peripheral

59
Q

_____________________ is a progressive and incurable disease characterized by degeneration, dysfunction, and eventual paralysis of upper and lower motor neurons

A

Amyotrophic lateral Sclerosis (ALS)

60
Q

what is the only medication approved for ALS disease modification rather than palliation of Sx

A

Riluzole

Brandon’s AFN Health Assessment (17 decks)

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