NBDE Quiz # 27
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NBDE Quiz # 27
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1. Question
You are observing an orthognathic surgery in the operating room, when the healthy patient, who is under general anesthesia, begins to develop hypercarbia, rigidity, elevated temperature, and tachycardia. The anesthetist has his hands full and asks you to get the medication that is used to treat this condition.
CorrectThe correct answer is D. This patient has malignant hyperthermia. It is believed to be triggered by halogenated general anesthetics and/or succinylcholine. Susceptibility to malignant hyperthermia is often inherited as an autosomal dominant disorder. The potential for malignant hyperthermia is caused in a large proportion (50%–70%) of cases by a mutation of the ryanodine receptor (type 1), located on the sarcoplasmic reticulum (SR), the organelle within skeletal muscle cells that store calcium. It results from the massive release of calcium from the sarcoplasmic reticulum into the skeletal muscle cell to cause persistent muscle contraction. Signs and symptoms include rigidity, fever, tachycardia, metabolic acidosis, hypercarbia, and hypoxia. Considering that the patient is ventilated and monitored by anesthesia, overdose is generally not a concern and can be controlled symptomatically.
Neuroleptic malignant syndrome (NMS) is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic instability, and cognitive changes such as delirium and is associated with elevated creatine phosphokinase (CPK). The setting and history of this presentation is unlikely to be caused by NMS.IncorrectThe correct answer is D. This patient has malignant hyperthermia. It is believed to be triggered by halogenated general anesthetics and/or succinylcholine. Susceptibility to malignant hyperthermia is often inherited as an autosomal dominant disorder. The potential for malignant hyperthermia is caused in a large proportion (50%–70%) of cases by a mutation of the ryanodine receptor (type 1), located on the sarcoplasmic reticulum (SR), the organelle within skeletal muscle cells that store calcium. It results from the massive release of calcium from the sarcoplasmic reticulum into the skeletal muscle cell to cause persistent muscle contraction. Signs and symptoms include rigidity, fever, tachycardia, metabolic acidosis, hypercarbia, and hypoxia. Considering that the patient is ventilated and monitored by anesthesia, overdose is generally not a concern and can be controlled symptomatically.
Neuroleptic malignant syndrome (NMS) is a life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs. It generally presents with muscle rigidity, fever, autonomic instability, and cognitive changes such as delirium and is associated with elevated creatine phosphokinase (CPK). The setting and history of this presentation is unlikely to be caused by NMS.