By: Prof. Dr. Fazal Rehman | Last updated: September 13, 2024
What is the primary trigger for malignant hyperthermia?
a) Opioids
b) Inhaled anesthetics
c) Local anesthetics
d) Muscle relaxantsAnswer: b) Inhaled anesthetics
Which inhaled anesthetic is most commonly associated with malignant hyperthermia?
a) Desflurane
b) Nitrous oxide
c) Sevoflurane
d) HalothaneAnswer: d) Halothane
Which genetic mutation is most commonly associated with malignant hyperthermia?
a) SCN4A
b) RYR1
c) CACNA1S
d) DMPKAnswer: b) RYR1
What is a hallmark sign of malignant hyperthermia during anesthesia?
a) Hypotension
b) Hyperthermia
c) Bradycardia
d) HypoglycemiaAnswer: b) Hyperthermia
Which of the following is a key early symptom of malignant hyperthermia?
a) Muscle rigidity
b) Nausea
c) Rash
d) HeadacheAnswer: a) Muscle rigidity
Which medication is the primary treatment for malignant hyperthermia?
a) Dantrolene
b) Lidocaine
c) Atropine
d) NaloxoneAnswer: a) Dantrolene
How should dantrolene be administered in cases of malignant hyperthermia?
a) Intravenously
b) Orally
c) Intramuscularly
d) SubcutaneouslyAnswer: a) Intravenously
What is the recommended dose of dantrolene for the initial treatment of malignant hyperthermia?
a) 2.5 mg/kg
b) 5 mg/kg
c) 10 mg/kg
d) 15 mg/kgAnswer: a) 2.5 mg/kg
Which of the following is NOT a symptom of malignant hyperthermia?
a) Rapidly increasing body temperature
b) Muscle rigidity
c) Hypotension
d) HyperkalemiaAnswer: c) Hypotension
What laboratory abnormality is commonly associated with malignant hyperthermia?
a) Hypoglycemia
b) Hypercalcemia
c) Hyperkalemia
d) HypernatremiaAnswer: c) Hyperkalemia
Which of the following conditions is a contraindication for the use of dantrolene?
a) Liver disease
b) Renal disease
c) Cardiac disease
d) Respiratory diseaseAnswer: a) Liver disease
What is the most critical step in managing a suspected case of malignant hyperthermia?
a) Administering intravenous fluids
b) Discontinuing triggering agents
c) Starting oxygen therapy
d) Administering antibioticsAnswer: b) Discontinuing triggering agents
Which diagnostic test is used to confirm a diagnosis of malignant hyperthermia?
a) Serum electrolyte levels
b) Muscle biopsy
c) Electrocardiogram (ECG)
d) Arterial blood gas (ABG)Answer: b) Muscle biopsy
Which environmental factor can exacerbate malignant hyperthermia?
a) High humidity
b) Low oxygen levels
c) Cold temperatures
d) Low ambient pressureAnswer: a) High humidity
What is the purpose of cooling measures in the management of malignant hyperthermia?
a) To prevent respiratory distress
b) To reduce metabolic rate
c) To prevent renal failure
d) To minimize muscle painAnswer: b) To reduce metabolic rate
Which of the following is a common sign of muscle damage in malignant hyperthermia?
a) Myoglobinuria
b) Jaundice
c) Edema
d) CyanosisAnswer: a) Myoglobinuria
What type of muscle relaxant should be avoided in patients with a history of malignant hyperthermia?
a) Non-depolarizing muscle relaxants
b) Depolarizing muscle relaxants
c) Benzodiazepines
d) OpioidsAnswer: b) Depolarizing muscle relaxants
Which of the following is a common preventive measure for patients with a known risk of malignant hyperthermia?
a) Using desflurane
b) Avoiding halothane
c) Administering dantrolene prophylactically
d) Using non-triggering anestheticsAnswer: d) Using non-triggering anesthetics
What is the role of intravenous fluids in the treatment of malignant hyperthermia?
a) To increase muscle relaxation
b) To correct electrolyte imbalances
c) To improve blood pressure
d) To provide pain reliefAnswer: b) To correct electrolyte imbalances
Which symptom is least likely to be observed in a case of malignant hyperthermia?
a) Fever
b) Rapid heartbeat
c) Cyanosis
d) Excessive sweatingAnswer: d) Excessive sweating
What is a common complication of untreated malignant hyperthermia?
a) Liver failure
b) Renal failure
c) Cardiac arrest
d) Pulmonary embolismAnswer: c) Cardiac arrest
Which monitoring technique is essential for detecting malignant hyperthermia during surgery?
a) Continuous temperature monitoring
b) Pulse oximetry
c) Blood pressure measurement
d) ElectrocardiographyAnswer: a) Continuous temperature monitoring
In which type of surgery is the risk of malignant hyperthermia most significant?
a) Orthopedic surgery
b) Gynecological surgery
c) General surgery
d) Cardiac surgeryAnswer: a) Orthopedic surgery
Which condition can increase the risk of malignant hyperthermia in susceptible individuals?
a) Hyperthyroidism
b) Diabetes mellitus
c) Asthma
d) Cystic fibrosisAnswer: a) Hyperthyroidism
What is the primary mechanism of action of dantrolene in treating malignant hyperthermia?
a) Enhancing muscle relaxation
b) Inhibiting calcium release from the sarcoplasmic reticulum
c) Blocking neuromuscular junctions
d) Reducing muscle toneAnswer: b) Inhibiting calcium release from the sarcoplasmic reticulum
What type of anesthesia should be used cautiously in patients with a family history of malignant hyperthermia?
a) General anesthesia
b) Epidural anesthesia
c) Spinal anesthesia
d) Regional anesthesiaAnswer: a) General anesthesia
Which of the following can help in the early detection of malignant hyperthermia during surgery?
a) Regular monitoring of end-tidal CO2
b) Frequent blood glucose checks
c) Monitoring intraoperative urine output
d) Assessing pupil sizeAnswer: a) Regular monitoring of end-tidal CO2
What should be done immediately if malignant hyperthermia is suspected?
a) Start cooling the patient
b) Administer muscle relaxants
c) Discontinue the triggering agent
d) Administer oxygenAnswer: c) Discontinue the triggering agent
Which of the following is NOT a common feature of malignant hyperthermia?
a) Elevated body temperature
b) Muscle rigidity
c) Hypothermia
d) TachycardiaAnswer: c) Hypothermia
What is the role of sodium bicarbonate in the management of malignant hyperthermia?
a) To treat metabolic acidosis
b) To reduce muscle rigidity
c) To enhance the effects of dantrolene
d) To correct electrolyte imbalancesAnswer: a) To treat metabolic acidosis
Which patient history is most relevant for assessing the risk of malignant hyperthermia?
a) History of muscle cramps
b) Family history of unexplained deaths during surgery
c) Previous surgeries without complications
d) History of cardiovascular diseaseAnswer: b) Family history of unexplained deaths during surgery
Which condition is a known contraindication for the use of dantrolene?
a) Liver dysfunction
b) Hypertension
c) Diabetes mellitus
d) AsthmaAnswer: a) Liver dysfunction
What is a critical component of post-anesthesia care in patients with malignant hyperthermia?
a) Frequent monitoring of vital signs
b) Administration of analgesics
c) Use of antiemetics
d) Routine blood transfusionsAnswer: a) Frequent monitoring of vital signs
How does malignant hyperthermia affect the muscle cells?
a) It causes a decrease in calcium levels
b) It leads to an increase in calcium release from the sarcoplasmic reticulum
c) It inhibits muscle contraction
d) It decreases muscle toneAnswer: b) It leads to an increase in calcium release from the sarcoplasmic reticulum
Which preventive measure is recommended for patients with a known susceptibility to malignant hyperthermia?
a) Preoperative administration of dantrolene
b) Use of muscle relaxants
c) Avoidance of halothane and succinylcholine
d) Routine liver function testsAnswer: c) Avoidance of halothane and succinylcholine
What is the role of cooling measures in malignant hyperthermia management?
a) To alleviate pain
b) To prevent muscle damage
c) To decrease the metabolic rate
d) To increase muscle relaxationAnswer: c) To decrease the metabolic rate
Which other condition might present similarly to malignant hyperthermia and needs differentiation?
a) Heat stroke
b) Hypoglycemia
c) Hyperthyroidism
d) HypocalcemiaAnswer: a) Heat stroke
What type of surgical environment can help in preventing malignant hyperthermia?
a) Low humidity and controlled temperature
b) High humidity and warm temperature
c) High oxygen levels and cold temperature
d) Low oxygen levels and warm temperatureAnswer: a) Low humidity and controlled temperature
Which physiological parameter is crucial for monitoring in suspected malignant hyperthermia?
a) Blood glucose levels
b) Core body temperature
c) Urine output
d) Blood pressureAnswer: b) Core body temperature
What is the effect of hyperkalemia in malignant hyperthermia?
a) It leads to arrhythmias
b) It reduces muscle rigidity
c) It causes hypoventilation
d) It decreases body temperatureAnswer: a) It leads to arrhythmias
Which of the following is the least likely sign of malignant hyperthermia?
a) Increased heart rate
b) Decreased muscle tone
c) Elevated body temperature
d) Muscle rigidityAnswer: b) Decreased muscle tone
What should be done if a patient with malignant hyperthermia develops acute renal failure?
a) Administer diuretics
b) Initiate dialysis
c) Increase fluid intake
d) Administer corticosteroidsAnswer: b) Initiate dialysis
Which of the following medications is NOT effective in the treatment of malignant hyperthermia?
a) Dantrolene
b) Sodium bicarbonate
c) Calcium channel blockers
d) InsulinAnswer: d) Insulin
Which anesthetic agent should be used with caution in patients with a history of malignant hyperthermia?
a) Isoflurane
b) Propofol
c) Fentanyl
d) KetamineAnswer: a) Isoflurane
What is the significance of muscle biopsy in the diagnosis of malignant hyperthermia?
a) It confirms the presence of RYR1 mutation
b) It measures calcium levels in muscle tissue
c) It assesses muscle damage
d) It helps in differentiating from other conditionsAnswer: a) It confirms the presence of RYR1 mutation
What is a common management strategy for hyperthermia in malignant hyperthermia cases?
a) Administration of antipyretics
b) Cooling the patient with ice packs
c) Increasing room temperature
d) Use of fansAnswer: b) Cooling the patient with ice packs
Which of the following can be used to manage the elevated CO2 levels associated with malignant hyperthermia?
a) Hyperbaric oxygen therapy
b) Sodium bicarbonate
c) Dantrolene
d) DiureticsAnswer: b) Sodium bicarbonate
What is a key factor in the rapid identification of malignant hyperthermia during surgery?
a) Monitoring for changes in blood pressure
b) Regular temperature checks
c) Observing for signs of nausea
d) Assessing pupil dilationAnswer: b) Regular temperature checks
Which population is most at risk for malignant hyperthermia?
a) Adults over 60
b) Children under 10
c) Adolescents and young adults
d) Pregnant womenAnswer: c) Adolescents and young adults
What type of patient history is most indicative of a risk for malignant hyperthermia?
a) Family history of unexplained perioperative deaths
b) History of asthma
c) Previous surgeries with no complications
d) Chronic kidney diseaseAnswer: a) Family history of unexplained perioperative deaths