Valley: Neuromusclar Diseases

Question 1

Are muscular dystrophy neuromuscular diseases hereditary?

Answer 1

Yes

Question 2

Painless degeneration and atrophy of skeletal muscles (associated with mental retardation)

Answer 2

Muscular dystrophy

Question 3

What are the 4 classifications of muscular dystrophy?

Answer 3

1. Pseudohypertrophic muscular dystrophy
2. Limb-girdle muscular dystrophy
3. Facioscapulohumeral muscular dystrophy (heart not involved)
4. Nemaline rod muscular dystrophy

Question 4

Which classification has the characteristics of: CHF, recurrent pneumonia, kyphoscoliosis, hyperkalemia with sux, susceptible to MH

Answer 4

Pseudohypertrophic muscular dystrophy

Question 5

Which classification has the characteristics of: micrognathia, bulbar palsy

Answer 5

Nemaline rod muscular dystrophy

Question 6

Which muscular dystrophy is the most common and most severe?

Answer 6

Duchenne’s muscular dystrophy

Question 7

Is duchenne’s muscular dystrophy x or y / dominant or recessive DNA?

Answer 7

X-linked recessive

Question 8

Duchenne’s muscular dystrophy affects the lung volume in what 2 ways?

Answer 8

1. Reduce total lung capacity
2. Reduce residual volume

Question 9

What type of heart block is common with Duchenne’s muscular dystrophy?

Answer 9

Bundle branch block

Question 10

Duchenne’s muscular dystrophy has an increased incidence of ——, so avoid —.

Answer 10

Malignant hyperthermia , succinylcholine

Question 11

Characterized by random and multiple sites of demyelination of corticospinal tract neurons in the brain and spinal cord, exclusive of the peripheral neurons.

Answer 11

Multiple sclerosis

Question 12

S/s of which neuromuscular disease: visual disturbances, ataxia, limb paresthesia and weakness, spastic paresis of skeletal muscles, exacerbations and remission

Answer 12

Multiple sclerosis

Question 13

What are the 5 common treatments (palliative) for multiple sclerosis?

Answer 13

1. Corticosteroids
2. Avoid stress
3. Avoid marked temperature changes
4. Dantrolene
5. Carbamazepine

Question 14

Multiple sclerosis management of anesthesia: — in response to succinylcholine

Answer 14

Hyperkalemia

Question 15

Multiple sclerosis management of anesthesia: prevent — body temperature postoperatively

Answer 15

Increased

Question 16

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

Answer 16

Myasthenia Gravis

Question 17

What are the 5 most common signs and symptoms with myasthenia gravis:

Answer 17

1. Ptosis and diplopia
2. Weakness of pharyngeal and laryngeal muscles (aspiration risk!)
3. Asymmetric extremity skeletal muscle weakness (atrophy absent!)
4. Cardiomyopathy
5. Hypothyroidism

Question 18

What are the 5 most common treatments for myasthenia gravis:

Answer 18

1. Anticholinesterase drugs
2. Corticosteroids
3. Cyclosporine
4. Plasmapheresis
5. Thymectomy (elective operation)

Question 19

Myasthenia Gravis preoperative preparation: — opioids and inform pt of possible —— postoperative

Answer 19

Avoid , mechanism ventilation

Question 20

Myasthenia gravis induction: —— IV drugs , tracheal intubation — muscle relaxants

Answer 20

Short acting , without

Question 21

Can you use muscle relaxants for maintenance with Myasthenia Gravis pts?

Answer 21

Yes, short or intermediate acting muscle relaxants

Question 22

Myasthenia Gravis postoperative: skeletal muscle strength may — abruptly

Answer 22

Decrease

Question 23

Degenerative disease of the CNS characterized by loss of dopaminergic fibers in the basal ganglia of the brain

Answer 23

Parkinson’s Disease

Question 24

— is an inhibitory neurotransmitter acting on the extrapyramidal motor system in Parkinson’s Disease

Answer 24

Dopamine

Question 25

What are the 4 most common signs and symptoms with Parkinson’s Disease?

Answer 25

1. Skeletal muscle rigidity 2. Resting tremor 3. Diaphragmatic spasms 4. Mental depression

Question 26

What are the 3 most common treatments for Parkinson’s Disease?

Answer 26

Increase concentration of dopamine 1. Levodopa (combo with decarboxylase inhibitor) 2. Anticholinergic drugs 3. Antihistamine drugs

Question 27

— levodopa therapy during management of anesthesia for Parkinson’s Disease

Answer 27

Continue

Question 28

Parkinson’s Disease will have a — BP and cardiac — during management of anesthesia.

Answer 28

Labile , dysrhythmias

Question 29

What 3 drugs do you avoid in Parkinson’s Disease with management of anesthesia?

Answer 29

Avoid drugs with antidopaminergic effects 1. Droperidol !! 2. Possibly opioids 3. Reglan

Question 30

Chronic inflammatory disease characterized by symmetric polyarthropathy and significant systemic involvement.

Answer 30

Rheumatoid Arthritis

Question 31

Rheumatoid arthritis has — vertebral involvement but no — involvement.

Answer 31

Cervical , sacroiliac

Question 32

Rheumatoid arthritis is most common in — that are — - — years old.

Answer 32

Females , 30-50

Question 33

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

Answer 33

Keratoconjunctivitis Sicca

Question 34

What are the 4 most common treatments for rheumatoid arthritis?

Answer 34

1. Aspirin 2. Corticosteroids 3. Gold 4. Surgery

Question 35

Airway evaluation for rheumatoid arthritis includes — disease

Answer 35

Restrictive

Question 36

Rheumatoid arthritis includes hoarseness or stridor, due to —— involvement.

Answer 36

Cricoarytenoid joint

Question 37

Rheumatoid arthritis may need — intubation and postoperative —.

Answer 37

Fiberoptic , ventilation

Question 38

Degenerative process that affects the articular cartilage and differs from rheumatoid arthritis due to lack of (or minimal) inflammatory reaction.

Answer 38

Osteoarthritis

Question 39

Osteoarthritis will have degenerative changes are primarily in the middle to lower — spine and in the lower — area.

Answer 39

Cervical , lumbar

Question 40

Would you treat osteoarthritis with corticosteroids?

Answer 40

NO

Question 41

Lateral curvature of spine

Answer 41

Scoliosis

Question 42

— scoliosis is most common type.

Answer 42

Idiopathic

Question 43

— pattern of breathing with thoracic scoliosis.

Answer 43

Restrictive

Question 44

What 6 lung measurements will decrease with scoliosis?

Answer 44

1. Vital capacity 2. Total lung capacity 3. Inspiratory volume 4. Functional residual capacity 5. Inspiratory capacity 6. ERV

Question 45

What is the only lung measurement that may be normal with scoliosis?

Answer 45

Residual volume

Question 46

FEV1/FVC is — in scoliosis.

Answer 46

Normal

Question 47

Scoliosis may develop elevated ——— and —— leading to right heart failure.

Answer 47

Pulmonary vascular resistance , pulmonary hypertension

Question 48

This cardiac valve issue is the most common abnormality with scoliosis.

Answer 48

Mitral valve prolapse

Question 49

Pts with neuromuscular scoliosis may lose — ml/kg.

Answer 49

75

Question 50

Deliberate — with the blood pressure in scoliosis pts because you — want to compromise spinal cord blood flow and to what MAP is desired?

Answer 50

Hypotension , do not , MAP 60-65 mmHg

Question 51

Parameters for extubation with pts having scoliosis: Vital capacity, tidal volume, spontaneous respiration rate, and negative inspiratory force.

Answer 51

Vital capacity: >10ml/kg Tidal volume: >3ml/kg Spontaneous respiration rate: <30/min Negative inspiratory force: >-30cmH2O

Question 52

What are the 5 most common complications with scoliosis?

Answer 52

1. Pneumothorax 2. Atelectasis 3. Pleural effusion 4. Hemothorax 5. Neurologic injury

Question 53

With scoliosis pts, avoid — and favor — drugs.

Answer 53

Succinylcholine , nitrous oxide