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Musculoskeletal Disease Flashcards

1
Q

What causes Myasthenia Gravis?

A

Autoimmune destruction of POST junctional nicotinic acetylcholine receptors

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2
Q

Key features of MG are:

A

Muscle fatigue that gets works as the day progresses

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3
Q

Removal of ______ can improve symptoms of myasthenia gravis

A

The thymus

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4
Q

What situations exacerbate MG?

A
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5
Q

What are the early symptoms of MG?

A
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6
Q

What is the first line treatment for MG?

A
  1. ORAL PYRIDOSTIGMINE
  2. Immunosuppression
  3. Thymectomy
  4. Plasmapheresis
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7
Q

What test is used to determine whether muscle weakness is caused by MG?

A
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8
Q

In terms of NM blockade, MG creates sensitivity to ________ and resistance to _______

A

sensitivity to non-depolarizers

resistance to depolarizers

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9
Q

In a patient with MG, what is an appropriate dose of Rocuronium?

A

You should reduce your dose by 1/2 to 2/3 and give repeat doses based on ToF

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10
Q

If you have to give a patient with MG succinylcholine, what dose is appropriate?

A

1.5 - 2 mg/kg

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11
Q

Will a patient with MG who receives succinylcholine have a decreased or increased duration of action?

A

Increased. Pyridostigmine is an acetylcholinesterase inhibitor, so break down of Succ will be delayed

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12
Q

All patients with MG are at risk for requiring postoperative ventilation, but this risk is especially high in which circumstances?

A
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13
Q

What causes Eaton-Lambert Syndrome?

A

IgG mediated destruction of PREsynaptic voltage-gated CALCIUM channels

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14
Q

What are alternative names of Eaton Lambert Syndrome?

A

Myasthenic Syndrome
LEMS

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15
Q

How does ELS impact acetylcholine receptors?

A

It doesn’t! It inhibits PRE synaptic calcium channels, which means Ach is never released into the NMJ

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16
Q

Which muscles are effected by ELS?

A

The proximal muscles first (opposite of MG)

Eventually the diaphragm and respiratory muscles

Worst in the morning and improves throughout the day (opposite of MG)

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17
Q

What is the treatment for ELS?

A

DAP, which increases Ach release by presynaptic neurons

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18
Q

Which cholinesterase inhibitor is recommended for ELS?

A

NONE! Cholinesterase inhibitors are not helpful, and a Tensilon test is not diagnostic

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19
Q

Which NMBA should be used in patients with ELS?

A

They have increased sensitivity to BOTH

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20
Q

Which comorbidity is present in 60% of ELS patients?

A

Small cell carcinoma.

If a patient is coming in for surgery to remove an SCC, you should be suspicious they may have presynaptic dysfunction and be judicious with NMBAs

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21
Q

What causes Guillain-Barre syndrome?

A

Autoimmune destruction of the myelin sheath in peripheral nerves

Action potentials can’t be conducted

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22
Q

When does GBS occur?

A

1-3 weeks after a flu-like illness

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23
Q

How long does GBS last?

A

2-4 weeks

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24
Q

What are the most common causes of GBS?

A

Campylobacter
Mono
CMV
Vaccines
Surgery
Lymph Disease

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25
What are the s/s of GBS?
26
What is the treatment for GBS?
Plasmapheresis IVIG Steroids are NOT helpful
27
How do patients with GBS respond to ephedrine?
They have an exaggerated response, because sympathetic receptors upregulate in an attempt to improve conduction
28
What is another name for GBS?
Acute idiopathic polyneuritis
29
Which NMBAs should be used for patients with GBS?
Succ should be avoided because they have upregulated receptors They will be MORE sensitive to non-depolarizers
30
What is familial periodic paralysis?
The blanket disorder for HYPO-PP and HYPER-PP
31
HypoPP is exacerbated by:
Glucose-insulin infusions that reduce serum potassium levels
32
HyperPP is exacerbated by:
Potassium infusion
33
Both types of familial periodic paralysis are treated with:
Acetazolamide Strict avoidance of HYPOthermia
34
Which NMBAs should be used in patients with FPP?
Never Succ With HyperPP (because it increases K) but also with HypoPP, because it's often associated with MH
35
Which medications should be avoided in the patient with HypoPP
All MH triggering agents
36
There are three coexisting diseases that are DEFINITIVELY related to MH:
King-Denborough Central Core Disease Multiminicore Disease
37
Which four states have the highest incidence of MH?
Wisconsin Nebraska West Virginia Michigan
38
How long after exposure can an MH crisis occur?
Up to 6 hours later!
39
Which diseases should be considered in an MH differential?
Thyroid Storm Pheochromocytoma Serotonin Syndrome Cocaine Intoxication
40
What is trismus?
A tight jaw that can still be opened. It's a common effect of Succ and is NOT the same as a masseter spasm
41
What is masseter rigidity?
A tight jaw that CANNOT be opened
42
Can masseter rigidity be resolved with Roc?
No. The problem is with the calcium outflow, downstream of anything the NMBA can effect
43
Which drug class should absolutely never be used during an MH crisis?
Calcium Channel Blockers Coadministration with dantrolene can cause life-threatening hyperkalemia
44
What is the immediate treatment for MH?
45
What is the MOA of dantrolene?
46
When should you stop dantrolene?
When symptoms of hypermetabolism subside
47
When a patient in MH crisis moves into the ICU, how should dantrolene be given?
48
What dose of calcium and insulin should be given to control hyperkalemia during an MH crisis?
49
If dysrhythmias occur during an MH crisis, which drugs can be used?
Procainamide or Lidocaine NOTHING WITH CCB ACTION!
50
How long should a patient be monitored in the ICU after an MH incident?
At least 48 hours. MH can reoccur up to 36 hours later
51
What causes DMD?
An absence of dystrophin leaves the sarcolemma unmoored and subject to destruction during normal muscle contraction
52
Why does DMD cause hyperkalemia with Succ?
Absence of dystrophin allows extrajunctional receptors to populate the sarcolemma
53
What are the respiratory effects of DMD?
They develop kyphoscoliosis, leading to restrictive lung disease AND have respiratory muscle weakness
54
What are the cardiac effects of DMD?
55
What EKG changes may be seen in patients with DMD?
56
What are the GI effects of DMD?
They have delayed gastric emptying
57
What is the Cobb Angle?
Measures severity of kyphoscoliosis
58
What Cobb angle necessitates surgery?
59
How does severe kyphoscoliosis impact cardiac function?
These patients have pHTN due to restrictive disease, so they have right sided heart failure They very commonly also have mitral valve prolapse
60
How does RA impact the airway?
61
What is the most common airway complication with RA?
atlantoaxial subluxation
62
What is rheumatoid arthritis?
An autoimmune disease that targets SYNOVIAL joints
63
What are the most common SLE exacerbating triggers?
64
Treatment of SLE includes:
65
Are patients with SLE hyper or hypocoaguable?
They may have a prolonged aPTT, but they're prone to hypercoagulability and thrombosis
66
What are the most common complications from Ehlers Danlos?
AAA and bleeding into joints (because the vessels are damaged)
67
Which disease can cause a blue sclera?
Osteogenesis imperfecta
68
Myotonic dystrophy is characterized by:
a prolonged contracture after a voluntary contraction
69
What three things should you avoid in the patient with myotonic dystrophy?
Succ Ach reversal after NMB Hypothermia
70

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