Musculoskeletal quick hits Flashcards
What disease should hyperthermia be avoided in? Why?
MS - Signs and symptoms can be exacerbated by heat
Which fluid should be avoided in patients with hypokalemic periodic paralysis?
D5W - dextrose can cause a shift of K into the cells and exacerbate skeletal muscle weakness
Which condition is similar to MH and is characterized by hyperkalemia and rhabdomyolysis?
Duchenne’s
Dosage for dantrolene?
2.5mg/kg IV every 5 minutes till hypermetabolism subsides
What is CREST syndrome?
Type of scleroderma
Calcinosis
Raynaud’s
Esophageal hypomotility
Sclerodactyly
Telangiectasia
How often must a charcoal filter be changed with a patient with MH
Every hour
What is Myasthenia Gravis? What disease is associated with it?
Autoimmune IgG
Nn receptor dysfunction on the post junctional receptor motor end plate
Thymoma
First line treatment for MG?
Oral pyridostigmine
What is the Tensilon test?
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
Treatment for cholinergic crisis?
Anticholinergic
How will paralytics affect MG?
Sensitive to non depolarizes
Resistant to Succ
What is Lambert Eaton syndrome? What disease is common with this?
Destruction of voltage gated calcium channels
Small cell lung carcinoma
How do paralytics affect Eaton Lambert ?
Increased sensitivity to Succ
Eaton Lambert or MG, AchE inhibitors have low efficacy?
Eaton Lambert
What is Guillain-Barre? (acute idiopathic polyneuritis)
Ascending paralysis that is preceded by flu like illness
What is Familial periodic paralysis?
Group of diseases that intermittently attacks skeletal muscle and causes weakness
Hypo and hyperkalemia
What is myotonic dystrophy?
Prolonged muscle contracture after a voluntary skeletal muscle movement
What is Charcot-Marie-Tooth?
Peripheral neuropathy that presents as weakness
Usually lower third of the legs
How is Guilian Barre treated?
IV IgG and Plasmapheresis
Do steroids or interferon improve outcomes on Guilian Barre?
No
What anesthetic is preferred in GB? Should Succ be avoided?
General
Yes - avoid succ
What is the treatment for both variants of periodic familial paralysis?
Acetazolamide
Is glucose and beta 2 agonists safe in hypo or hyperkalemic periodic familial paralysis?
Safe in hyper because it shifts it lower. Don’t give in hypokalemia
What must be avoided at all costs in periodic paralysis?
Hypothermia - MAINTAIN NORMOTHERMIA
MH affects which receptor ?
Ryanodine - RYR1
Is Duchenne’s a risk factor for MH?
NO
What three diseases are risk factors for MH?
King Denborough
Central core disease
Multiminicore disease
What are three early signs of MH?
Masseter spasm
Increased EtCO2
Tachycardia
Tachypnea
Warm soda lime
What is trismus?
A tight jaw that can be opened and responds to succ
What is masseter muscle rigidity?
Tight jaw that cannot be opened and does not respond to succ
Should dantrolene be D/C if venous irritation is observed?
NO
What drug class should be avoided with MH?
CCBs (verapamil)
What is Duchenne’s? What lab value will be observed ? EKG findings?
Absence of dystrophin
CK leaks through muscle cell and is elevated
Deep Q waves in limb leads
Increased R wave in lead I
What changes occur in the lung with Duchenne’s? What doesn’t happen?
Decreased pulmonary reserve from kyphoscoliosis
Increased secretions and aspiration
Respiratory muscle weakness
NO PULMONARY FIBROSIS
Children with DMD are susceptible to what life threatening condition?
Hyperkalemia after Succ
What is Cobbs angle and go through each degree
Measurement of scoliosis
50- Need surgery
60-Pulmonary reserve decreases
70-Pulmonary symptoms appear
100- High risk of post op complications
*** What region of the spinal cord do somatosensory evoked potentials monitor?
Posterior or dorsal column
What is the most common RA airway complication?
Atlantoaxial subluxation and separation of the atlanto-odontoid articulation
What is the first line treatment of RA? What else is used?
NSAIDS
Glucocorticoids
What three things will you see in patients with RA?
Anemia
Pleural effusion
Aortic regurgitation
others:
Bleeding (from aspirin)
Hyperglycemia (from steroids)
Restrictive lung disease
Treatment for lupus?
Hydrocortisone and cyclophosphamide
NSAIDS
Antimalarials
mnemonic for SLE?
Pissed Chimp
Which immunosuppressant increases the duration of succ?
Cyclophosphamide. inhibits plasma cholinesterase
What disease has spontaneous bleeding into the joints?
Ehlers - Danlos
Procollagen and collagen disorder
Careful with anything that punctures (regional, IM, line placement)
What disease has blue sclera and brittle bones?
Osteogenesis Imperfecta
Connective tissue disorder
BP cuff can cause a fracture
Serum thyroxine is increased
Which disease has a high risk of spontaneous pneumothorax?
Marfan
Also
-Aortic regurgitation
-Aortic dissection
Pagets disease has a risk of what?
Bone fracture
Excess osteoblastic and clastic activity - causes thick and weak bones
Which disease has bulbar muscle dysfunction?
MS
How does scleroderma affect the airway?
Skin fibrosis - limits mouth mobility
Telangiectasis - increased risk of mucosal bleeding
