NEURO CRAP

Question 1

Autonomic hyperreflexia: injury above ___

Answer 1

usually T6 or above

always T10 or above

Question 2

Autonomic hyperreflexia: triggered by ___

Answer 2

stimulation of hollow organs below injury
childbirth
bowel movement
cutaneous stimulation

Question 3

Autonomic hyperreflexia: hemodynamics

Answer 3

constrict below
bradycardia, HTN
dilate above (but can't communicate with area below)

Question 4

Autonomic hyperreflexia: s/s

Answer 4

HTN
Brady
nasal stuffiness
blurred vision
headache

Question 5

ALS: begins where?

Answer 5

hands

Question 6

ALS: patho

Answer 6

degeneration of motor neurons

does NOT affect occulor muscles

Question 7

ALS: most common cause death

Answer 7

respiratory failure

Question 8

ALS: succs/nondepolarizers

Answer 8

because of up regulation, DO NOT use succs (hyperkalemia)

extra sensitive to nondepolarizers (they are weak to begin with hello)

Question 9

MG: patho

Answer 9

autoimmune
IgG blocks post junctional Ach nicotinic receptors, so same amount of Ach but not enough working receptors
skeletal muscle weakness late in day

Question 10

MG: what surgery/body part affected?

Answer 10

thymus

thymomectomy

Question 11

MG and preggo:

Answer 11

worse in pregnancy

IgG crosses placenta, neonate can be weak after delivery

Question 12

MG treatment:

Answer 12

anti cholinesterase (pyridostigmine)
overdose can cause cholinergic crisis

Question 13

Eaton Lambert Syndrome: patho

Answer 13

IgG destroy PRE synaptic calcium channel (so less Ach release)
often seen side by side with MG

Question 14

Eaton Lambert Syndrome: musculature

Answer 14

affects proximal muscles first

weakness worse in morning

Question 15

Eaton Lambert Syndrome: succs/NDMR

Answer 15

increased sensitivity to succinylcholine

increased sensitivity to NDMR

Question 16

Eaton Lambert Syndrome: body part associated/comorbidity seen?

Answer 16

small cell carcinoma of lung

Question 17

MG: succs/NMDR

Answer 17

because less post junctional receptors, less NDMR needed
so MORE sensitive to roc/NMDR

prolonged duration of succinylcholine, because pyridostigmine impairs pseudocholinesterase
resistant to succinylcholine

Question 18

GBS other name:

Answer 18

acute idiopathic polyneuritis

Question 19

GBS patho

Answer 19

myelin in peripheral nerves destroyed
paralysis follows flu-like illness
paralysis moves distal to proximal
lasts 2-4 weeks

Question 20

GBS most common culprits

Answer 20

EBV, CMV, campylobacter

Question 21

GBS treatment

Answer 21

plasmapheresis, IV IgG

Question 22

GBS succs/NDMR

Answer 22

succs no (upregulation)
increased sensitivity to NDMR (already weak hello)

also increased response to ephedrine

Question 23

Familial Periodic Paralysis treatment

Answer 23

could be hypo or hyperkalemic

treatment is acetazolamide for both

Question 24

Familial Period Paralysis succs/NDMR:

Answer 24

hypokalemic: NDMR ok but short acting (roc) better, succs questionable
hyperkalemic: NDMR ok, no succs

Question 25

Muscular dystrophy patho

Answer 25

no dystrophin x-linked recessive predisposed hyperkalemia

Question 26

muscular dystrophy MH

Answer 26

NOT linked increased risk MH like syndrome that's hyperkalemia and rhabdo triggered by succs

Question 27

seen with muscular dystrophy

Answer 27

``` kyphoscoliosis resp muscle weakness deep Q waves increased aspiration risk degeneration cardiac muscle unstable sarcolemma, leaky muscle cell membrane ```

Question 28

scoliosis surgery needed when:

Answer 28

Cobb angle greater than 40-50

Question 29

myotonic dystrophy management (3)

Answer 29

avoid succs avoid hypothermia avoid anticholinesterase

Question 30

MS patho

Answer 30

demyelination CNS

Question 31

MS anesthesia/succs:

Answer 31

avoid hyperthermia avoid spinals** NO SUCCS ** spinal could exacerbate symptoms: need to know per apex even though clinically not significant

Question 32

Scleroderma patho/SE:

Answer 32

``` fibrosis HTN pulmonary HTN limited mouth opening CREST syndrome, raynauds ```

Question 33

there is NO increased risk MH in what 4 muscular disorders?

Answer 33

Becker muscular dystrophy neuroleptic malignant syndrome myotonia congenita myotonic dystrophy

Question 34

MH is definitively linked to:

Answer 34

King-Deborough syndrome Central core disease Multiminicore disease

Question 35

things that exacerbate SLE

Answer 35

``` PISSED CHIMP Preggo Infection Surgery Stress Enalapril D-penicillamine Captopril Hydralazine Isoniazid Methyldopa Procainamide ```

Question 36

RA three airway issues:

Answer 36

TMJ- decreased mouth opening Cricoarytenoid: decreased diameter glottic opening C-spine: AO sublaxation, limited extension

Question 37

most common airway problem in RA:

Answer 37

``` AO sublaxation (AO sublaxation is when distance between interior arch of atlas and the odontoid process is greater than 3mm) ```

Question 38

RA complications:

Answer 38

``` aortic regurgitation anemia pleural effusion restrictive ventilatory defect morning stiffness because NSAIDs first line, may bleed ```

Question 39

Alzheimers key points/treatment:

Answer 39

beta amyloid plaque, dysfunctional synapse (not as much Ach) apoptosis (programmed cell death) treatment to restore Ach - give cholinesterase inhibitors

Question 40

Alzheimers and succs:

Answer 40

succs prolonged, increased duration of action

Question 41

Parkinsons patho

Answer 41

chronic neurodegenerative disorder of the basal ganglia destruction of dopaminergic neurons relative increase in Ach increased GABA activity in thalamus

Question 42

parkinsons diagnosis:

Answer 42

pill rolling tremor skeletal muscle rigidity postural instability bradykinesia

Question 43

parkinsons treatment

Answer 43

levodopa and carbidopa (need to give together --> potentiation) anticholinergics

Question 44

Parkinson's anesthesia key points

Answer 44

antidopaminergic drugs bad risk for autonomic instability, orthostatic hypotension, arrhythmia, aspiration anticholinergics can be used for exacerbation (Benadryl has these properties) succs and NDMR fine ketamine controversial