Valley: Neuromusclar Diseases Flashcards
Are muscular dystrophy neuromuscular diseases hereditary?
Yes
Painless degeneration and atrophy of skeletal muscles (associated with mental retardation)
Muscular dystrophy
What are the 4 classifications of muscular dystrophy?
- Pseudohypertrophic muscular dystrophy
- Limb-girdle muscular dystrophy
- Facioscapulohumeral muscular dystrophy (heart not involved)
- Nemaline rod muscular dystrophy
Which classification has the characteristics of: CHF, recurrent pneumonia, kyphoscoliosis, hyperkalemia with sux, susceptible to MH
Pseudohypertrophic muscular dystrophy
Which classification has the characteristics of: micrognathia, bulbar palsy
Nemaline rod muscular dystrophy
Which muscular dystrophy is the most common and most severe?
Duchenne’s muscular dystrophy
Is duchenne’s muscular dystrophy x or y / dominant or recessive DNA?
X-linked recessive
Duchenne’s muscular dystrophy affects the lung volume in what 2 ways?
- Reduce total lung capacity
- Reduce residual volume
What type of heart block is common with Duchenne’s muscular dystrophy?
Bundle branch block
Duchenne’s muscular dystrophy has an increased incidence of ——, so avoid —.
Malignant hyperthermia , succinylcholine
Characterized by random and multiple sites of demyelination of corticospinal tract neurons in the brain and spinal cord, exclusive of the peripheral neurons.
Multiple sclerosis
S/s of which neuromuscular disease: visual disturbances, ataxia, limb paresthesia and weakness, spastic paresis of skeletal muscles, exacerbations and remission
Multiple sclerosis
What are the 5 common treatments (palliative) for multiple sclerosis?
- Corticosteroids
- Avoid stress
- Avoid marked temperature changes
- Dantrolene
- Carbamazepine
Multiple sclerosis management of anesthesia: — in response to succinylcholine
Hyperkalemia
Multiple sclerosis management of anesthesia: prevent — body temperature postoperatively
Increased
A chronic autoimmune disease involving the neuromuscular junction. It is characterized by weakness and rapid exhaustion of skeletal muscles with repetitive use; in some recovery with rest
Myasthenia Gravis
What are the 5 most common signs and symptoms with myasthenia gravis:
- Ptosis and diplopia
- Weakness of pharyngeal and laryngeal muscles (aspiration risk!)
- Asymmetric extremity skeletal muscle weakness (atrophy absent!)
- Cardiomyopathy
- Hypothyroidism
What are the 5 most common treatments for myasthenia gravis:
- Anticholinesterase drugs
- Corticosteroids
- Cyclosporine
- Plasmapheresis
- Thymectomy (elective operation)
Myasthenia Gravis preoperative preparation: — opioids and inform pt of possible —— postoperative
Avoid , mechanism ventilation
Myasthenia gravis induction: —— IV drugs , tracheal intubation — muscle relaxants
Short acting , without
Can you use muscle relaxants for maintenance with Myasthenia Gravis pts?
Yes, short or intermediate acting muscle relaxants
Myasthenia Gravis postoperative: skeletal muscle strength may — abruptly
Decrease
Degenerative disease of the CNS characterized by loss of dopaminergic fibers in the basal ganglia of the brain
Parkinson’s Disease
— is an inhibitory neurotransmitter acting on the extrapyramidal motor system in Parkinson’s Disease
Dopamine
What are the 4 most common signs and symptoms with Parkinson’s Disease?
- Skeletal muscle rigidity
- Resting tremor
- Diaphragmatic spasms
- Mental depression
What are the 3 most common treatments for Parkinson’s Disease?
Increase concentration of dopamine
1. Levodopa (combo with decarboxylase inhibitor)
2. Anticholinergic drugs
3. Antihistamine drugs
— levodopa therapy during management of anesthesia for Parkinson’s Disease
Continue
Parkinson’s Disease will have a — BP and cardiac — during management of anesthesia.
Labile , dysrhythmias
What 3 drugs do you avoid in Parkinson’s Disease with management of anesthesia?
Avoid drugs with antidopaminergic effects
1. Droperidol !!
2. Possibly opioids
3. Reglan
Chronic inflammatory disease characterized by symmetric polyarthropathy and significant systemic involvement.
Rheumatoid Arthritis
Rheumatoid arthritis has — vertebral involvement but no — involvement.
Cervical , sacroiliac
Rheumatoid arthritis is most common in — that are — - — years old.
Females , 30-50
A condition marked by hyperemia of the conjunctiva, lacrimal deficiency, thickening of the corneal epithelium, itching and bruising of the eye, and often reduced visual acuity
Keratoconjunctivitis Sicca
What are the 4 most common treatments for rheumatoid arthritis?
- Aspirin
- Corticosteroids
- Gold
- Surgery
Airway evaluation for rheumatoid arthritis includes — disease
Restrictive
Rheumatoid arthritis includes hoarseness or stridor, due to —— involvement.
Cricoarytenoid joint
Rheumatoid arthritis may need — intubation and postoperative —.
Fiberoptic , ventilation
Degenerative process that affects the articular cartilage and differs from rheumatoid arthritis due to lack of (or minimal) inflammatory reaction.
Osteoarthritis
Osteoarthritis will have degenerative changes are primarily in the middle to lower — spine and in the lower — area.
Cervical , lumbar
Would you treat osteoarthritis with corticosteroids?
NO
Lateral curvature of spine
Scoliosis
— scoliosis is most common type.
Idiopathic
— pattern of breathing with thoracic scoliosis.
Restrictive
What 6 lung measurements will decrease with scoliosis?
- Vital capacity
- Total lung capacity
- Inspiratory volume
- Functional residual capacity
- Inspiratory capacity
- ERV
What is the only lung measurement that may be normal with scoliosis?
Residual volume
FEV1/FVC is — in scoliosis.
Normal
Scoliosis may develop elevated ——— and —— leading to right heart failure.
Pulmonary vascular resistance , pulmonary hypertension
This cardiac valve issue is the most common abnormality with scoliosis.
Mitral valve prolapse
Pts with neuromuscular scoliosis may lose — ml/kg.
75
Deliberate — with the blood pressure in scoliosis pts because you — want to compromise spinal cord blood flow and to what MAP is desired?
Hypotension , do not , MAP 60-65 mmHg
Parameters for extubation with pts having scoliosis:
Vital capacity, tidal volume, spontaneous respiration rate, and negative inspiratory force.
Vital capacity: >10ml/kg
Tidal volume: >3ml/kg
Spontaneous respiration rate: <30/min
Negative inspiratory force: >-30cmH2O
What are the 5 most common complications with scoliosis?
- Pneumothorax
- Atelectasis
- Pleural effusion
- Hemothorax
- Neurologic injury
With scoliosis pts, avoid — and favor — drugs.
Succinylcholine , nitrous oxide
