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Neuromuscular Blockade

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Diplomat of ABA Medicine (Fundamental Topics in Anesthesiology) Quiz on Neuromuscular Blockade, created by Mike Ru on 28/04/2018.
Mike Ru
Quiz by Mike Ru, updated more than 1 year ago
Mike Ru
Created by Mike Ru about 6 years ago
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Resource summary

Question 1

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

Question 2

Question
A patient taking which of the following drugs would most commonly be associated with resistance to (nondepolarizing) NMB drugs:
Answer
  • Quinidine
  • Phenytoin
  • Cyclophosphamide
  • Aminoglycosides
  • Magnesium

Question 3

Question
The MOST important parameter that determines the speed of onset for NMB drugs is:
Answer
  • Potency
  • Lipophilicity
  • Ionization
  • Plasma clearance
  • E. Receptor affinity

Question 4

Question
A characteristic common to current aminosteroid-based NMB drugs such as vecuronium or rocuronium is:
Answer
  • Significant histamine release after a bolus injection
  • Vagolysis producing tachycardia
  • Hofmann elimination
  • Deacetylation in the liver
  • Production of laudanosine as the primary metabolite

Question 5

Question
Clinical data support that when the TOFR exceeds [blank_start]__[blank_end], anesthesia providers have trouble assessing the presence of fade
Answer
  • 0.4
  • 0.2
  • 0.7
  • 0.9

Question 6

Question
TOF count of 3 would equate to a twitch suppression of [blank_start]__[blank_end]%
Image:
Tofc (binary/octet-stream)
Answer
  • 55
  • 75
  • 85
  • 90

Question 7

Question
Once the TOF ratio exceeds [blank_start]0.60[blank_end], fade to DBS generally cannot be detected subjectively
Image:
Dbs (binary/octet-stream)
Answer
  • 0.60
  • 0.40
  • 0.70
  • 0.85

Question 8

Question
What is true about Tetanic stimulation (TET)?
Image:
Tet (binary/octet-stream)
Answer
  • 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

Question 9

Question
Which statement about posttetanic count is NOT correct?
Image:
Ptc (binary/octet-stream)
Answer
  • 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

Question 10

Question
Correct statements about objective monitoring techniques include:
Answer
  • 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

Question 11

Question
All of the following are examples of Benzylisoquinolinium compounds consist of two quaternary ammonium groups joined by methyl groups EXCEPT:
Answer
  • D-tubocurarine
  • Atracurium
  • Mivacurium
  • Pancuronium
  • Cisatracurium

Question 12

Question
Train-of-four (TOF) has all of the following characteristics, EXCEPT:
Image:
Tof (binary/octet-stream)
Answer
  • 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)

Question 13

Question
Double burst stimulation (DBS) characteristics include all of the following, EXCEPT:
Image:
Dbs (binary/octet-stream)
Answer
  • 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

Question 14

Question
Potential side-effects associated with the use of succinylcholine include all of the below, EXCEPT:
Answer
  • Myalgia
  • Tachycardia
  • Anaphylaxis
  • Hyperkalemia

Question 15

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

Question 16

Question
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:
Answer
  • Verapamil
  • Dexamethasone
  • Ranitidine
  • Odansetron
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