Muscoskeletal 2 Flashcards by Bryan Groff

Does MG get better or worse throughout the day?

Worse

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Earliest sign of MG?

Ptosis

also

Bulbar muscle weakness

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Treatment for MG?

Oral pyridostigmine

Steroids

Thymectomy

Plasmapheresis

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MG vs EL ; adequate response to AchE inhibitors

MG has good response

EL has a poor response

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Which disease attacks the myelin sheath ? Treatment?

Guillain Barre

IV Igg and plasmapheresis

Avoid succ

Steroids are not useful

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What disease does interferon help treat?

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What disease should ephedrine be avoided?

Gullian-Barre

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What is the treatment for hypo/hyper periodic paralysis?

Acetazolamide

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What should be avoided in periodic paralysis?

Hypothermia at all costs

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What channel is affected with hypokalemic PP? Hyper?

Hypo - Calcium

Hyper - Sodium

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How is hyper PP diagnosed? hypo?

Hypo - symptoms get worse after glucose

Hyper- symptoms get worse after giving K

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Three diseases linked to MH?

Multiminicore
Central core
King Denborough

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Steps for MH?

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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Consequences of increased Ca

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

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First S+S of MH?

Masseter spasms
Increased Co2
Tachycardia
Warm soda lime
Tachypnea

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Second S+S of MH

Cyanosis
Patient warm

Late S+S of MH

Muscle rigidity
Cola-colored urine
Coagulopathy
Hyperthermia

S+S of all three stages of MH?

Irregular heart

Gold standard of MH testing?

Caffeine-halothane contracture (muscle biopsy)

What drug is contradicted in the treatment of MH?

CCBs

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

20mg Dantrolene
3g mannitol

Must be with preservative water NOT 0.9% NS

Dose of dantrolene? How long?

2.5mg/kg repeat every 5-10min

Can continue in ICU 1mg/kg

Steps for treating MH?

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

How often should charcoal filter be changed?

Every hour

Considerations of Duchenne's

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

What should be avoided in Duchenne's

Succ and volatile anesthetics

Normal PFT in scoliosis? Abnormal PFT?

Normal FEV1/FVC ratio Abnormal FEV1 and FRC

Most common airway complication of RA?

Atlantoaxial subluxation and separation of the atlanto-odotoid articulation

Considerations for RA?

Anemia Aortic regurgitation Pulmonary effusion Restrictive disease NSAIDS Hyperglycemia

Treatment for lupus?

Steroids NSAID Immunosuppressants Antimalarials

Considerations for lupus?

Increase risk for airway swelling **aPTT is prolonged but at risk for clotting Increased duration of succ from cyclophosphamide

Considerations for Marfan?

at risk for AAA, spontaneous pneumo, pregnancy increases risk

Considerations for Ehlers Danlos

Spontaneous bleeding avoid regional, IM, line placement

Considerations for osteogenesis imperfecta

Blue sclera - increased risk for fracture Connective tissue disorder Increased serum thyroxine Increased fractures -even from BP cuff Arterial hypoxemia

Paget's disease considerations

Pain and fractures are most common Caused by excessive parathyroid hormone Cause thick and weak bones No vascular involvement

What is scleroderma?

Causes fibrosis of skin and organs