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Neuro > Muscoskeletal 2 > Flashcards

Muscoskeletal 2 Flashcards

1
Q

Does MG get better or worse throughout the day?

A

Worse

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2
Q

Earliest sign of MG?

A

Ptosis

also

Bulbar muscle weakness

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3
Q

Treatment for MG?

A

Oral pyridostigmine

Steroids

Thymectomy

Plasmapheresis

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4
Q

MG vs EL ; adequate response to AchE inhibitors

A

MG has good response

EL has a poor response

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5
Q

Which disease attacks the myelin sheath ? Treatment?

A

Guillain Barre

IV Igg and plasmapheresis

Avoid succ

Steroids are not useful

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6
Q

What disease does interferon help treat?

A
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7
Q

What disease should ephedrine be avoided?

A

Gullian-Barre

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8
Q

What is the treatment for hypo/hyper periodic paralysis?

A

Acetazolamide

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9
Q

What should be avoided in periodic paralysis?

A

Hypothermia at all costs

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10
Q

What channel is affected with hypokalemic PP? Hyper?

A

Hypo - Calcium

Hyper - Sodium

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11
Q

How is hyper PP diagnosed? hypo?

A

Hypo - symptoms get worse after glucose

Hyper- symptoms get worse after giving K

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12
Q

Three diseases linked to MH?

A

Multiminicore
Central core
King Denborough

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13
Q

Steps for MH?

A

T tubule depolarized - Ca enters through dihydropyridine

Activates RyR1

RYR1 can’t be turned off

SERCA2 pump activates

Consume all ATP, O2 depletes, massive rise in CO2

Sarcolemma breaks down and allows K and myoglobin into the systemic circulation

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14
Q

Consequences of increased Ca

A

Rigidity
Depletion of ATP
Increased O2 consumption
Increased CO2
Mixed respiratory and lactic acidosis
Sarcolemma breaks down

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15
Q

First S+S of MH?

A

Masseter spasms
Increased Co2
Tachycardia
Warm soda lime
Tachypnea

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16
Q

Second S+S of MH

A

Cyanosis
Patient warm

17
Q

Late S+S of MH

A

Muscle rigidity
Cola-colored urine
Coagulopathy
Hyperthermia

18
Q

S+S of all three stages of MH?

A

Irregular heart

19
Q

Gold standard of MH testing?

A

Caffeine-halothane contracture (muscle biopsy)

20
Q

What drug is contradicted in the treatment of MH?

A

CCBs

21
Q

What is Dantrolene a combination of ? How must it be reconstituted?

A

20mg Dantrolene
3g mannitol

Must be with preservative water NOT 0.9% NS

22
Q

Dose of dantrolene? How long?

A

2.5mg/kg repeat every 5-10min

Can continue in ICU 1mg/kg

23
Q

Steps for treating MH?

A

D/C agent

Call for help

Hyperventilate 100% 10L

Charcoal filter

Dantrolene

Cool patient

Sodium bicarb (treat acidosis)

Treat hyperkalemia

Class 1 antiarrhythmics (Lidocaine)

Maintain urine

Correct coag’s

24
Q

How often should charcoal filter be changed?

A

Every hour

25
Q

Considerations of Duchenne’s

A

Kyphoscoliosis -restrictive
Respiratiory muscle weakness

Degeneration of cardiac muscle
Increased R wave in lead I
Deep Q waves in limb leads

Increased risk of pulmonary aspiration

26
Q

What should be avoided in Duchenne’s

A

Succ and volatile anesthetics

27
Q

Normal PFT in scoliosis? Abnormal PFT?

A

Normal FEV1/FVC ratio

Abnormal FEV1 and FRC

28
Q

Most common airway complication of RA?

A

Atlantoaxial subluxation and separation of the atlanto-odotoid articulation

29
Q

Considerations for RA?

A

Anemia
Aortic regurgitation
Pulmonary effusion
Restrictive disease
NSAIDS
Hyperglycemia

30
Q

Treatment for lupus?

A

Steroids
NSAID
Immunosuppressants
Antimalarials

31
Q

Considerations for lupus?

A

Increase risk for airway swelling

**aPTT is prolonged but at risk for clotting

Increased duration of succ from cyclophosphamide

32
Q

Considerations for Marfan?

A

at risk for AAA, spontaneous pneumo, pregnancy increases risk

33
Q

Considerations for Ehlers Danlos

A

Spontaneous bleeding

avoid regional, IM, line placement

34
Q

Considerations for osteogenesis imperfecta

A

Blue sclera - increased risk for fracture

Connective tissue disorder

Increased serum thyroxine

Increased fractures -even from BP cuff

Arterial hypoxemia

35
Q

Paget’s disease considerations

A

Pain and fractures are most common
Caused by excessive parathyroid hormone

Cause thick and weak bones

No vascular involvement

36
Q

What is scleroderma?

A

Causes fibrosis of skin and organs

Neuro (7 decks)

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