M5 Neurology: Part 1

Front 1

Why do Parkinson's patients have problems with hypotension intraop?

How does this inform pressor selection?

Back 1

They are often catecholamine depleted.

Direct pressors are preferred, since there are few catecholamines to be released.

Front 2

This opioid is contraindicated in patients on MAOIs?

Why?

Back 2

Meperidine

Hemodynamic instability, hyperpyrexia, and coma can result

Front 3

After a traumatic brain injury, how long should anti-seizure be continued

Why

Back 3

1 week

Early seizures are usually caused by the injury, late seizures are usually an epilleptogenic process.

Front 4

Why is status epilepticus an emergency?

Back 4

Sustained neuronal oxygen consumption can lead to ischemia with permanent neurologic injury within 5 minutes.

Front 5

Are most cases of status epilepticus in patients with a seizure disorder?

Back 5

No, usually some other surgical or medical pathology such as anoxia, stroke, intracerebral hemorrhage, metabolic derangement, or alcohol withdrawal.

Front 6

What is the first step in managing an actively seizing patient?

Back 6

Airway... ABCs

Front 7

Which 3 induction agents can lower the seizure threshold?

Back 7

Etomidate, methohexital, and ketamine

Front 8

This induction agent can cause extrapyramidal myoclonus that can mimic clonic seizures?

Back 8

Etomidate

Front 9

What is the neurologic danger of meperidine?

Back 9

Its metabolite, noremeperidine, can accumulate in those with kidney failure and cause seizures

Front 10

Does an asymptomatic bruit increase the risk of perioperative stroke?

What can it be associated with?

Back 10

No.

Underlying CAD.

Front 11

If a person is having "posterior" TIAs (dizzyness, coordination, bilateral vision changes, weakness, amnesia, confusion) what vessels are likely to be affected (sending the emboli)

Back 11

verebrobasilar

Front 12

If a person is having TIAs with symptoms of unilateral weakness, unilateral sensory changes, unilateral vision changes, and aphasia what vessels are likely to be affected (sending emboli).

Back 12

internal carotid

Front 13

What does monitoring during a CEA help with the decision for?

Back 13

Whether or not to shunt flow around the clamp.

Front 14

What is the most common cause of intraoperative stroke during CEA?

Back 14

Embolism

Front 15

Myelomeningocele, spina bifida, genitourinary disease, indwelling tubes, and multiple surgeries, put children at risk for what?

Back 15

Latex allergy

Front 16

Banana, avacado, and kiwi allergies often coexist with what other allergy?

Back 16

Latex

Front 17

Can spinal anesthesia be used in a patient with MS?

Back 17

Most books recommend not to as it may lead to more flair ups, but there is no good evidence for not using it. Epidural anesthesia is generally considered safe, so choose that over spinal if the choice is available.

Front 18

This temperature change can exacerbate MS symptoms?

Back 18

Hyperthermia

Front 19

Is succinylcholine contraindicated in MS?

Back 19

Yes

Front 20

What are the three types of MS?

This type can over time turn into a progressive unremitting subtype known as secondary progressive?

Back 20

Relapsing remitting (most mild and common), progressive remitting (rare), and primary progressive (most severe)

Relapsing remitting

Front 21

This neuromuscular disorder puts the patient at increased risk of hyperkalemia and also a syndrome that resembles MH with Sch?

Back 21

Duchenne's muscular dystrophy

Front 22

Sch should not be used in this neuromuscular disorder because of worsening of their persistant contractions leading to inability to ventilate or intubate

Back 22

Myotonic dystrophy

Front 23

Is neuraxial anesthesia contraindicated in GBS?

Back 23

Yes, it may exacerbate syndromes

Front 24

3 Things to avoid in Myotonic Dystrophy

What is the airway concern?

Back 24

Sch (worsens contractures), neostigmine (wosens contractures), hypothermia (worsens contractions)

Contractions can be so bad intubation and ventillation become impossible

Front 25

What type of muscle relaxants are people with MG sensitive to?

What type of muscle relaxants are people with MG resistant to?

Back 25

NDNMBDs (there are less Ach receptors that need blocked)

Depolarizers (Sch) (there are less Ach receptors to agonize so more Sch is needed to create depolarization).

Front 26

Why is there an increased risk of phase II block in MG patients when using Sch?

Back 26

High doses must be used and these patients often take acetylcholinesterase inhibitors for their disease which inhibits Sch's metabolism.

Front 27

Thymus hyperplasia, thymomas, and Ach-R antibodies are associated with what?

Back 27

MG

Front 28

Do the MG types (I, IIa, IIb, III, and IV) have a more severe or more mild prognosis with the increasing number?

Back 28

More severe ( I is most mild IV is most severe)

Front 29

A patient with MG recently had their anticholinesterase increased, they feel weak. What test can be used to differentiate if this is due to worsening MG or cholinergic crisis from increased anticholineserase dose?

Back 29

Tensilon test - edrophonium is given if symptoms improve then it is worsening MG, if symptoms worsen then it is cholinergic crisis.

Front 30

What is the antidote to cholinergic crisis in a patient without MG?

Back 30

Atropine (or glycopyrrolate)