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Neuro > Musculoskeletal quick hits > Flashcards

Musculoskeletal quick hits Flashcards

1
Q

What disease should hyperthermia be avoided in? Why?

A

MS - Signs and symptoms can be exacerbated by heat

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2
Q

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

A

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

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3
Q

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

A

Duchenne’s

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4
Q

Dosage for dantrolene?

A

2.5mg/kg IV every 5 minutes till hypermetabolism subsides

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5
Q

What is CREST syndrome?

A

Type of scleroderma

Calcinosis
Raynaud’s
Esophageal hypomotility
Sclerodactyly
Telangiectasia

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6
Q

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

A

Every hour

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7
Q

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

A

Autoimmune IgG

Nn receptor dysfunction on the post junctional receptor motor end plate

Thymoma

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8
Q

First line treatment for MG?

A

Oral pyridostigmine

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9
Q

What is the Tensilon test?

A

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

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10
Q

Treatment for cholinergic crisis?

A

Anticholinergic

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11
Q

How will paralytics affect MG?

A

Sensitive to non depolarizes

Resistant to Succ

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12
Q

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

A

Destruction of voltage gated calcium channels

Small cell lung carcinoma

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13
Q

How do paralytics affect Eaton Lambert ?

A

Increased sensitivity to Succ

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14
Q

Eaton Lambert or MG, AchE inhibitors have low efficacy?

A

Eaton Lambert

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15
Q

What is Guillain-Barre? (acute idiopathic polyneuritis)

A

Ascending paralysis that is preceded by flu like illness

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16
Q

What is Familial periodic paralysis?

A

Group of diseases that intermittently attacks skeletal muscle and causes weakness

Hypo and hyperkalemia

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17
Q

What is myotonic dystrophy?

A

Prolonged muscle contracture after a voluntary skeletal muscle movement

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18
Q

What is Charcot-Marie-Tooth?

A

Peripheral neuropathy that presents as weakness

Usually lower third of the legs

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19
Q

How is Guilian Barre treated?

A

IV IgG and Plasmapheresis

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20
Q

Do steroids or interferon improve outcomes on Guilian Barre?

A

No

21
Q

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

A

General

Yes - avoid succ

22
Q

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

A

Acetazolamide

23
Q

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

A

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

24
Q

What must be avoided at all costs in periodic paralysis?

A

Hypothermia - MAINTAIN NORMOTHERMIA

25
Q

MH affects which receptor ?

A

Ryanodine - RYR1

26
Q

Is Duchenne’s a risk factor for MH?

A

NO

27
Q

What three diseases are risk factors for MH?

A

King Denborough
Central core disease
Multiminicore disease

28
Q

What are three early signs of MH?

A

Masseter spasm
Increased EtCO2
Tachycardia
Tachypnea
Warm soda lime

29
Q

What is trismus?

A

A tight jaw that can be opened and responds to succ

30
Q

What is masseter muscle rigidity?

A

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

31
Q

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

A

NO

32
Q

What drug class should be avoided with MH?

A

CCBs (verapamil)

33
Q

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

A

Absence of dystrophin

CK leaks through muscle cell and is elevated

Deep Q waves in limb leads
Increased R wave in lead I

34
Q

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

A

Decreased pulmonary reserve from kyphoscoliosis

Increased secretions and aspiration

Respiratory muscle weakness

NO PULMONARY FIBROSIS

35
Q

Children with DMD are susceptible to what life threatening condition?

A

Hyperkalemia after Succ

36
Q

What is Cobbs angle and go through each degree

A

Measurement of scoliosis
50- Need surgery

60-Pulmonary reserve decreases

70-Pulmonary symptoms appear

100- High risk of post op complications

37
Q

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

A

Posterior or dorsal column

38
Q

What is the most common RA airway complication?

A

Atlantoaxial subluxation and separation of the atlanto-odontoid articulation

39
Q

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

A

NSAIDS

Glucocorticoids

40
Q

What three things will you see in patients with RA?

A

Anemia

Pleural effusion

Aortic regurgitation

others:

Bleeding (from aspirin)
Hyperglycemia (from steroids)
Restrictive lung disease

41
Q

Treatment for lupus?

A

Hydrocortisone and cyclophosphamide

NSAIDS
Antimalarials

42
Q

mnemonic for SLE?

A

Pissed Chimp

43
Q

Which immunosuppressant increases the duration of succ?

A

Cyclophosphamide. inhibits plasma cholinesterase

44
Q

What disease has spontaneous bleeding into the joints?

A

Ehlers - Danlos

Procollagen and collagen disorder

Careful with anything that punctures (regional, IM, line placement)

45
Q

What disease has blue sclera and brittle bones?

A

Osteogenesis Imperfecta

Connective tissue disorder

BP cuff can cause a fracture

Serum thyroxine is increased

46
Q

Which disease has a high risk of spontaneous pneumothorax?

A

Marfan

Also
-Aortic regurgitation
-Aortic dissection

47
Q

Pagets disease has a risk of what?

A

Bone fracture

Excess osteoblastic and clastic activity - causes thick and weak bones

48
Q

Which disease has bulbar muscle dysfunction?

A

MS

49
Q

How does scleroderma affect the airway?

A

Skin fibrosis - limits mouth mobility

Telangiectasis - increased risk of mucosal bleeding

Neuro (7 decks)

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