Musculoskeletal quick hits

Question 1

What disease should hyperthermia be avoided in? Why?

Answer 1

MS - Signs and symptoms can be exacerbated by heat

Question 2

Which fluid should be avoided in patients with hypokalemic periodic paralysis?

Answer 2

D5W - dextrose can cause a shift of K into the cells and exacerbate skeletal muscle weakness

Question 3

Which condition is similar to MH and is characterized by hyperkalemia and rhabdomyolysis?

Answer 3

Duchenne’s

Question 4

Dosage for dantrolene?

Answer 4

2.5mg/kg IV every 5 minutes till hypermetabolism subsides

Question 5

What is CREST syndrome?

Answer 5

Type of scleroderma

Calcinosis
Raynaud’s
Esophageal hypomotility
Sclerodactyly
Telangiectasia

Question 6

How often must a charcoal filter be changed with a patient with MH

Answer 6

Every hour

Question 7

What is Myasthenia Gravis? What disease is associated with it?

Answer 7

Autoimmune IgG

Nn receptor dysfunction on the post junctional receptor motor end plate

Thymoma

Question 8

First line treatment for MG?

Answer 8

Oral pyridostigmine

Question 9

What is the Tensilon test?

Answer 9

Edrophonium is given 1-2 mg IV

If muscle weakness is worse then in cholinergic crisis

If muscle weakness is better then the patient had an exacerbation of myasthenic symptoms

Question 10

Treatment for cholinergic crisis?

Answer 10

Anticholinergic

Question 11

How will paralytics affect MG?

Answer 11

Sensitive to non depolarizes

Resistant to Succ

Question 12

What is Lambert Eaton syndrome? What disease is common with this?

Answer 12

Destruction of voltage gated calcium channels

Small cell lung carcinoma

Question 13

How do paralytics affect Eaton Lambert ?

Answer 13

Increased sensitivity to Succ

Question 14

Eaton Lambert or MG, AchE inhibitors have low efficacy?

Answer 14

Eaton Lambert

Question 15

What is Guillain-Barre? (acute idiopathic polyneuritis)

Answer 15

Ascending paralysis that is preceded by flu like illness

Question 16

What is Familial periodic paralysis?

Answer 16

Group of diseases that intermittently attacks skeletal muscle and causes weakness

Hypo and hyperkalemia

Question 17

What is myotonic dystrophy?

Answer 17

Prolonged muscle contracture after a voluntary skeletal muscle movement

Question 18

What is Charcot-Marie-Tooth?

Answer 18

Peripheral neuropathy that presents as weakness

Usually lower third of the legs

Question 19

How is Guilian Barre treated?

Answer 19

IV IgG and Plasmapheresis

Question 20

Do steroids or interferon improve outcomes on Guilian Barre?

Answer 20

No

Question 21

What anesthetic is preferred in GB? Should Succ be avoided?

Answer 21

General

Yes - avoid succ

Question 22

What is the treatment for both variants of periodic familial paralysis?

Answer 22

Acetazolamide

Question 23

Is glucose and beta 2 agonists safe in hypo or hyperkalemic periodic familial paralysis?

Answer 23

Safe in hyper because it shifts it lower. Don’t give in hypokalemia

Question 24

What must be avoided at all costs in periodic paralysis?

Answer 24

Hypothermia - MAINTAIN NORMOTHERMIA

Question 25

MH affects which receptor ?

Answer 25

Ryanodine - RYR1

Question 26

Is Duchenne's a risk factor for MH?

Answer 26

NO

Question 27

What three diseases are risk factors for MH?

Answer 27

King Denborough Central core disease Multiminicore disease

Question 28

What are three early signs of MH?

Answer 28

Masseter spasm Increased EtCO2 Tachycardia Tachypnea Warm soda lime

Question 29

What is trismus?

Answer 29

A tight jaw that can be opened and responds to succ

Question 30

What is masseter muscle rigidity?

Answer 30

Tight jaw that cannot be opened and does not respond to succ

Question 31

Should dantrolene be D/C if venous irritation is observed?

Answer 31

NO

Question 32

What drug class should be avoided with MH?

Answer 32

CCBs (verapamil)

Question 33

What is Duchenne's? What lab value will be observed ? EKG findings?

Answer 33

Absence of dystrophin CK leaks through muscle cell and is elevated Deep Q waves in limb leads Increased R wave in lead I

Question 34

What changes occur in the lung with Duchenne's? What doesn't happen?

Answer 34

Decreased pulmonary reserve from kyphoscoliosis Increased secretions and aspiration Respiratory muscle weakness NO PULMONARY FIBROSIS

Question 35

Children with DMD are susceptible to what life threatening condition?

Answer 35

Hyperkalemia after Succ

Question 36

What is Cobbs angle and go through each degree

Answer 36

Measurement of scoliosis 50- Need surgery 60-Pulmonary reserve decreases 70-Pulmonary symptoms appear 100- High risk of post op complications

Question 37

*** What region of the spinal cord do somatosensory evoked potentials monitor?

Answer 37

Posterior or dorsal column

Question 38

What is the most common RA airway complication?

Answer 38

Atlantoaxial subluxation and separation of the atlanto-odontoid articulation

Question 39

What is the first line treatment of RA? What else is used?

Answer 39

NSAIDS Glucocorticoids

Question 40

What three things will you see in patients with RA?

Answer 40

Anemia Pleural effusion Aortic regurgitation others: Bleeding (from aspirin) Hyperglycemia (from steroids) Restrictive lung disease

Question 41

Treatment for lupus?

Answer 41

Hydrocortisone and cyclophosphamide NSAIDS Antimalarials

Question 42

mnemonic for SLE?

Answer 42

Pissed Chimp

Question 43

Which immunosuppressant increases the duration of succ?

Answer 43

Cyclophosphamide. inhibits plasma cholinesterase

Question 44

What disease has spontaneous bleeding into the joints?

Answer 44

Ehlers - Danlos Procollagen and collagen disorder Careful with anything that punctures (regional, IM, line placement)

Question 45

What disease has blue sclera and brittle bones?

Answer 45

Osteogenesis Imperfecta Connective tissue disorder BP cuff can cause a fracture Serum thyroxine is increased

Question 46

Which disease has a high risk of spontaneous pneumothorax?

Answer 46

Marfan Also -Aortic regurgitation -Aortic dissection

Question 47

Pagets disease has a risk of what?

Answer 47

Bone fracture Excess osteoblastic and clastic activity - causes thick and weak bones

Question 48

Which disease has bulbar muscle dysfunction?

Answer 48

MS

Question 49

How does scleroderma affect the airway?

Answer 49

Skin fibrosis - limits mouth mobility Telangiectasis - increased risk of mucosal bleeding