Neuromuscular Blockade

Question 1 of 16

1

Use of succinylcholine to facilitate endotracheal intubation would be acceptable (“safe”) in which one of the following situations:

Select one of the following:

80 y.o. female patient 2 days after 40% body surface area burn
18 y. o. male one week after spinal cord transection injury
12 y.o. with Duchene’s muscular dystrophy
22 y. o. with evolving respiratory failure secondary to Guillian-Barre’
27 y. o. female with myasthenia gravis

Explanation

Question 2 of 16

1

A patient taking which of the following drugs would most commonly be associated with resistance to (nondepolarizing) NMB drugs:

Select one of the following:

Quinidine
Phenytoin
Cyclophosphamide
Aminoglycosides
Magnesium

Explanation

Question 3 of 16

1

The MOST important parameter that determines the speed of onset for NMB drugs is:

Select one of the following:

Potency
Lipophilicity
Ionization
Plasma clearance
E. Receptor affinity

Explanation

Question 4 of 16

1

A characteristic common to current aminosteroid-based NMB drugs such as vecuronium or rocuronium is:

Select one of the following:

Significant histamine release after a bolus injection
Vagolysis producing tachycardia
Hofmann elimination
Deacetylation in the liver
Production of laudanosine as the primary metabolite

Explanation

Question 5 of 16

1

Select from the dropdown list to complete the text.

Clinical data support that when the TOFR exceeds ( 0.4, 0.2, 0.7, 0.9 ),
anesthesia providers have trouble assessing the presence
of fade

Explanation

Question 6 of 16

1

Select from the dropdown list to complete the text.

TOF count of 3 would equate to a twitch suppression of ( 55, 75, 85, 90 )%

Explanation

Question 7 of 16

1

Select from the dropdown list to complete the text.

Once the TOF ratio exceeds ( 0.60, 0.40, 0.70, 0.85 ), fade to DBS generally cannot be detected subjectively

Explanation

Question 8 of 16

1

What is true about Tetanic stimulation (TET)?

Select one of the following:

During partial depolarizing block, fade is not observed in response to tetanic stimulation
Tetanic stimulation is not painful
Muscular fatigue usually develop at a stimulation frequency of 50 Hz
Fade is thought to be an effect of a depolarizing agent on the presynaptic nerve membrane

Explanation

Question 9 of 16

1

Which statement about posttetanic count is NOT correct?

Select one of the following:

The number of posttetanic count twitches is inversely related to time until the first regular TOF twitch returns
Posttetanic count used when TOF or DBS is absent to estimate recovery time
Posttetanic count uses tetany followed by TOF at frequency of 1 Hz
The main use of posttetanic count is when profound neuromuscular block is not required

Explanation

Question 10 of 16

1

Correct statements about objective monitoring techniques include:

Select one of the following:

Mechanomyography (MMG) measures isotonic contraction of peripheral muscles in response to nerve stimulation
Acceleromyography (AMG) calculates the force of contraction of a muscle using a miniature piezoelectric transducer
Electromyography (EMG) measures the electrical activity (compound muscle action potential) of a stimulated muscle
Kinemyography (KMG) detects the acceleration of the thumb contraction in response to electrical stimulation of a nerve

Explanation

Question 11 of 16

1

All of the following are examples of Benzylisoquinolinium compounds consist of two quaternary ammonium groups joined by methyl groups EXCEPT:

Select one of the following:

D-tubocurarine
Atracurium
Mivacurium
Pancuronium
Cisatracurium

Explanation

Question 12 of 16

1

Train-of-four (TOF) has all of the following characteristics, EXCEPT:

Select one of the following:

TOF consists of four ST stimuli at a frequency of 4 Hz
TOF does not require a “baseline” or “control” muscle response
TOF “fade” is defined as a weaker fourth twitch than the first twitch
TOF is delivered every 15-20 sec to prevent potentiation of subsequent responses
TOF ratios >0.40 cannot be reliably detected subjectively (visually or tactilely)

Explanation

Question 13 of 16

1

Double burst stimulation (DBS) characteristics include all of the following, EXCEPT:

Select one of the following:

The two mini-tetanic bursts are separated by 0.5 sec
DBS is delivered no more frequently than every 20 sec to prevent subsequent response potentiation
In DBS, similar to TOF pattern, no control (“baseline”) muscle response is needed
DBS ratios >0.60 cannot be reliably detected by subjective (tactile, visual) means
In awakening patients, DBS is more painful than TOF, but less so than tetanic stimulation

Explanation

Question 14 of 16

1

Potential side-effects associated with the use of succinylcholine include all of the below, EXCEPT:

Select one of the following:

Myalgia
Tachycardia
Anaphylaxis
Hyperkalemia

Explanation

Question 15 of 16

1

Since sugammadex has no direct cholinergic properties, anesthesiologist do not require the ready availability of an anticholinergic like glycopyrrolate at the time of reversal.

Select one of the following:

True
False

Explanation

Question 16 of 16

1

When administering sugammadex through a peripheral IV, it is important to note that the drug has a physical incompatibility with all of the following drugs except:

Select one of the following:

Verapamil
Dexamethasone
Ranitidine
Odansetron

	Created by Mike Ru about 6 years ago

Diplomat of ABA Medicine (Fundamental Topics in Anesthesiology) Quiz on Neuromuscular Blockade, created by Mike Ru on 28/04/2018.

Neuromuscular Blockade

Question 1 of 16

Use of succinylcholine to facilitate endotracheal intubation would be acceptable (“safe”) in which one of the following situations:

Select one of the following:

Explanation

Question 2 of 16

A patient taking which of the following drugs would most commonly be associated with resistance to (nondepolarizing) NMB drugs:

Select one of the following:

Explanation

Question 3 of 16

The MOST important parameter that determines the speed of onset for NMB drugs is:

Select one of the following:

Explanation

Question 4 of 16

A characteristic common to current aminosteroid-based NMB drugs such as vecuronium or rocuronium is:

Select one of the following:

Explanation

Question 5 of 16

Select from the dropdown list to complete the text.

Clinical data support that when the TOFR exceeds 0.4 0.2 0.7 0.9( 0.4, 0.2, 0.7, 0.9 ), anesthesia providers have trouble assessing the presence of fade

Explanation

Question 6 of 16

Select from the dropdown list to complete the text.

TOF count of 3 would equate to a twitch suppression of 55 75 85 90( 55, 75, 85, 90 )%

Explanation

Question 7 of 16

Select from the dropdown list to complete the text.

Once the TOF ratio exceeds 0.60 0.40 0.70 0.85( 0.60, 0.40, 0.70, 0.85 ), fade to DBS generally cannot be detected subjectively

Explanation

Question 8 of 16

What is true about Tetanic stimulation (TET)?

Select one of the following:

Explanation

Question 9 of 16

Which statement about posttetanic count is NOT correct?

Select one of the following:

Explanation

Question 10 of 16

Correct statements about objective monitoring techniques include:

Select one of the following:

Explanation

Question 11 of 16

All of the following are examples of Benzylisoquinolinium compounds consist of two quaternary ammonium groups joined by methyl groups EXCEPT:

Select one of the following:

Explanation

Question 12 of 16

Train-of-four (TOF) has all of the following characteristics, EXCEPT:

Select one of the following:

Explanation

Question 13 of 16

Double burst stimulation (DBS) characteristics include all of the following, EXCEPT:

Select one of the following:

Explanation

Question 14 of 16

Potential side-effects associated with the use of succinylcholine include all of the below, EXCEPT:

Select one of the following:

Explanation

Question 15 of 16

Since sugammadex has no direct cholinergic properties, anesthesiologist do not require the ready availability of an anticholinergic like glycopyrrolate at the time of reversal.

Select one of the following:

Explanation

Question 16 of 16

When administering sugammadex through a peripheral IV, it is important to note that the drug has a physical incompatibility with all of the following drugs except:

Select one of the following:

Explanation

Clinical data support that when the TOFR exceeds ( 0.4, 0.2, 0.7, 0.9 ),
anesthesia providers have trouble assessing the presence
of fade

TOF count of 3 would equate to a twitch suppression of ( 55, 75, 85, 90 )%

Once the TOF ratio exceeds ( 0.60, 0.40, 0.70, 0.85 ), fade to DBS generally cannot be detected subjectively