Guided Studies

Question 1

What causes malignant hyperthermia ?

Answer 1

-Genetic Disorder (RYR1geneonchromosome19 substituted, increasingtheprobabilitythattheCa2+‐releasechannelwillbeopen)
-Due to exposure toanyofthevarious
inhalationanestheticagents, particularlyhalothane.

Question 2

What are the signs and symptoms of malignant hyperthermia?

Answer 2

Tachypnea
Lowplasma[O2]
Highplasma[CO2]
Tachycardia(rapidheartrate),
Hyperthermia(risingbodytemperature)
Rigidity,sweating,anddramaticswingsinbloodpressure.

If untreated:
Respiratoryandlacticacidosis
Musclerigidity,
BreakdownofmuscletissueleadingtothereleaseofK+andthusprofoundhyperkalemia

Question 3

What medical interventions are used to treat malignant hyperthermia?

Answer 3

-Dantrolene (drug, blocksECcouplingbetweenTtubulesandtheSR,thusinterruptingtheotherwiseuncontrolled
progressionofmusclecontractions. May be given following onset, or prior to anaesthesia in at risk patients)
-Cessation of anaesthesia
-Aggressiveeffortsaimedatcoolingthebody
-Intravenoushydrationanduse
ofdiureticstokeeptheurineflowing (less damageto kidneysfromreleaseof
breakdownproducts,suchasmyoglobinfromthedamagedmuscles)
-Sodiumbicarbonatetocounterlacticacidosis
-mechanicalhyperventilationtoblowoffthe
excessCO2.

Question 4

What is the order for putting PPE on ? taking it off ?

Answer 4

Apron 
Gown
Mask
Eye Protection
Gloves

Gloves
Apron
Gown
Eye Protection  
Mask

Question 5

What is a shock ?

Answer 5

low blood perfusion to tissues resulting in cellular injury and inadequate tissue function

Question 6

List the different sub types of shock.

Answer 6

Hypovolaemic Shock
Cardiogenic Shock
Anaphylactic Shock
Septic Shock
Neurogenic

Question 7

What are symptoms of hypovolaemic shock ?

Answer 7

 Tachycardia
 Skin pallor
 Hypotension
 Confusion, aggression, drowsiness, and coma
 General weakness
 Thirst
 Reduced urine output

Question 8

Identify situations in which, due to altered physiologic responses the degree of blood loss may be miss-interpreted.

Answer 8

 Elderly population
 Patients on certain medications (e.g. beta-blockers, antihypertensives and antianginals)
 Patients with pacemakers
 Athletes
 Pregnancy
 Hypothermia

Question 9

What is the estimated blood loss for the following fractures ?
Pelvis 
Humerus
Tibia
Femur

Answer 9

Humerus: 0.5-1.5
Tibia: 0.5-1.5
Femur: 1.0-2.5
Pelvis: 1.0-4.0

Question 10

What are the main Lower motoneurone disorders ? Upper motoneurone disorders ?

Answer 10

LMN disorders: 
Flaccid paralysis
Atrophy
Fasciculation
Decreased muscle tone
Loss of tendon reflexes 
Weakness  (↓ power)

UMN disorders:
Spasticity
Exaggerated tendon reflexes
Babinski sign 
Increased muscle tone
Weakness (↓ power)

Question 11

What are the main symptoms of Thoracic Outlet Syndrome ?

Answer 11

• Irritation or compression of the neurovascular bundles, normally associated with the 1st rib (most commonly affects the subclavian artery and/or the lower trunk of the trunk of the brachial
• Symptoms may develop following trauma such as whiplash injury

Question 12

Which demographic group does the thoracic outlet syndrome affect most ?

Answer 12

females aged 20 – 40

Sportsmen, swimmers and throwers

Question 13

What are the causes of Thoracic Outlet Syndrome ?

Answer 13

-Due to narrowing or compression of the thoracic ‘outlet’
- Overall, this narrowing/compression due to:
• Cervical ribs or fibrous bands associated with partial cervical ribs
• Excessive callus formation following fracture of the clavicle
• Malignancy of the lung apex (Pancoast’s tumour)
• Inflammatory disease including rheumatoid arthritis,
fibromyalgia
• Poor posture, or disorders of posture such as kyphosis and scoliosis

Question 14

When may the symptoms of TOS appear ?

Answer 14

Following a traumatic accident (e.g. whiplash injury from road accident)

Question 15

How long is the interval between trauma and symptoms of TOS ?

Answer 15

Hours, to weeks

Question 16

What are the symptoms of TOS ?

Answer 16

• Pain, numbness or tingling of the upper limb (symptoms often vague and general and may affect the whole arm).
• Possibly, a painful neck and headache too
• Autonomic features (i.e. cold hands, swelling or blanching)
• Stellate ganglion involvement may also occur