Musculoskeletal EXTRAS

Question 1

With Duchenne Muscular Dystrophy (DMD), what blood test will be chronically elevated? By how much?

Answer 1

CK
20-100x normal

Question 2

What causes an increased CK in DMD?

Answer 2

increased permeability of skeletal muscle membranes and skeletal muscle necrosis

Question 3

By how much should we reduce a NMBA in a patient with MG if we need to paralyze them?

Answer 3

1/2 to 2/3 reduced dose, TTE

Question 4

What two agents can be used to intubate a patient with MG in place of an NMBA?

Answer 4

• volatile anesthetic
• remifentanil

Question 5

What two conditions exacerbate nephritis seen with SLE?

Answer 5

• HTN
• Pregnancy

Question 6

What exacerbates SLE?

Answer 6

• infection
• pregnancy
• surgery

Question 7

When are DMARDs indicated for MG treatment? What three DMARDs could be prescribed?

Answer 7

When skeletal muscle weakness is not adequately controlled by ACh-ase inhibitors
- azathioprine
- cyclosporine
- mycophenalate

Question 8

What are the three interrelated processes of scleroderma?

Answer 8

1. Autoimmune-mediated vasculitis
2. Fibrosis of skin and viscera from deposition of collagen
3. Microvascular changes produce tissue fibrosis and organ sclerosis

Question 9

What are the three main forms of scleroderma?

Answer 9

-localized scleroderma
- limited cutaneous system sclerosis
- diffuse cutaneous system sclerosis

Question 10

What is diffuse cutaneous system sclerosis?

Answer 10

rapidly progressive form, generalized skin involvement and cardiovascular complications with vascular involvement, CAD, cardiomyopathy, and HTN

Question 11

Which hypnotic induction agent is best suited for pulmonary HTN?

Answer 11

Etomidate

Question 12

What are potential s/e’s of methotrexate? What can reduce methotrexate toxicity?

Answer 12

• bone marrow suppression
  -cirrhosis

Folic acid can reduce methotrexate toxicity

Question 13

What are s/e’s of TNF-alpha inhibitors?

Answer 13

-infection (TB)
- demyelinating syndromes

Question 14

What can happen as a result of separation of the atlanto-odontoid articulation? Which disease process is this associated with?

Answer 14

Compression of the base of the spinal cord if the odontoid process protrudes through the foramen magnum. Rheumatoid Arthritis

Question 15

Is avascular necrosis associated with RA or SLE?

Answer 15

SLE

Question 16

Why are ACE-I’s indicated for scleroderma?

Answer 16

Renal Protection. Helps control hypertension and is the only drug shown to treat scleroderma renal crisis.

Question 17

Pericarditis is associated with SLE and what other musculoskeletal disorder?

Answer 17

Scleroderma.
Pericarditis and pericardial effusion

Question 18

What precipitates renal crisis seen in scleroderma? What is the treatment?

Answer 18

Corticosteroids; ACE-I’s

Question 19

If metoclopramide is ineffective in treating hypomotility associated with scleroderma, are there any other medications that can help?

Answer 19

Yes - Octreotide (somatostatin analogue)

Question 20

Volatile anesthetics increase the risk of _______ _________ and _________ in DMD patients. What anesthetic plan should be considered?

Answer 20

rhabdomyolysis, malignant hyperthermia

TIVA (total IV anesthesia) if general anesthesia is necessary over regional anesthetic

Question 21

How many types of Myasthenia Gravis are there? Which types are worse?

Answer 21

Type I through Type IV. Type IV is most severe

Question 22

What CV changes are associated with MG?

Answer 22

myocarditis, A-fib, cardiomyopathy

Question 23

Which -stigmine is the preferred first line of treatment for MG?

Answer 23

pyridostigmine. Max dose 120mg q3h

Question 24

Can metoclopramide help with myasthenia gravis?

Answer 24

Most certainly