Deck 15: Neuromuscular Diseases

Question 1

Which of the following is the major muscle of inspiration?

A)Rectus abdominus
B)Diaphragm
C)External oblique
D)Internal intercostals

Answer 1

B

Question 2

Which of these statements best describes the overall neurological control of respiration?

A)The rate,rhythm,and depth of respiration is predetermined by brain centers but subject to modification by incoming (sensory)stimuli
B)The brain centers pattern respiration partly using sensory input and partly by inherent autorhythmicity
C)The peripheral chemoreceptors contribute the most to the ventilatory response to hypercapnia
D)None of the above

Answer 2

B

Question 3

Conditions that can affect the neuromuscular function include all of the following except:

A)Organophosphate poisoning
B)Botulism
C)Nerve gases
D)Hyperthermia

Answer 3

D

Question 4

What is the response of the central (medullary)chemoreceptors to hypoxemia?

A)None
B)Brisk in contrast to the peripheral chemoreceptors
C)Slower but more sustained response than the peripheral chemoreceptors
D)Response augmented when hypercapnia also present

Question 5

All of the following are true regarding the role of the RT in the care of neuromuscular patients except:

A)RTs are in a good position to distinguish the various causes of respiratory failure
B)The formal in-depth training RTs receive in the neurosciences make them indispensable to the neurosurgeon
C)The care RTs provide to neurologic patients is often as basic as artificial airway placement and suctioning
D)RTs are trained to recognize early warning signs of respiratory failure

Question 6

Which of the following statements is true regarding amyotrophic lateral sclerosis?

A)It is also called Lou Gehrig's disease
B)It has no known cause
C)It results in damage to the anterior horn cell
D)All the above

Question 7

Which of the following is false regarding the expiratory muscles?

A)They are needed during passive exhalation to the point of functional residual capacity.
B)They include the abdominal wall muscles and the internal intercostals.
C)They are useful in forceful exhalation and coughing.
D)They fatigue easily during neuromuscular disease.

Question 8

Which peripheral nerve concerned with breathing is most vulnerable to injury?

A)Vagus
B)Phrenic
C)Thoracic nerves 1-12
D)None of the above

Question 9

What neurotransmitter is operable at the respiratory neuromuscular junctions?

A)Acetylcholine
B)Norepinephrine
C)Dopamine
D)Epinephrine

Question 10

What breathing pattern is seen in patients with acute neuromuscular disease that weakens the muscles of breathing?

A)Deep and fast
B)Rapid and shallow
C)Slow and deep
D)Slow and shallow

Question 11

What type of sleep apnea may play a role in sudden infant death syndrome?

A)Central
B)Obstructive
C)Both A and B
D)Mixed

Question 12

All of the following classes of drugs suppress respiration except:

A)Barbituates
B)Narcotics
C)Amphetamines
D)Benzodiazapines

Question 13

Where are the peripheral chemoreceptors for respiration located?

A)Pons
B)Cerebral cortex
C)Carotid arteries and aorta
D)All the above

Question 14

Which of the following determinations is NOT indicative of impending respiratory failure?

A)VC <1.0-1.5 in a small child
B)MIP <-20 cm H₂O in an adult
C)Decreased physiologic dead space
D)Decreased P(A-a)O₂

Question 15

Your trauma patient has transection of his lumbar spinal cord at level L5.Which respiratory muscles will be affected?

A)Diaphragm
B)Sternomastoids
C)Scalenes
D)None of the above

Question 16

Where does the phrenic nerve arise from the spine?

A)C1 to C2
B)C3 to C5
C)C5 to C7
D)T1 to T3

Question 17

Which of these room air ABGs represents acute weakness of the respiratory muscles?

A)pH 7.50,PCO₂ 30,PO₂ 55
B)pH 7.20,PCO₂ 60,PO₂ 55
C)pH 7.55,PCO₂ 40,PO₂ 100
D)None of the above

Question 18

Which of the following disorders represents a classic example of a disease that affects the neuromuscular junction?

A)Myasthenia gravis
B)Guillain-Barré syndrome
C)Polio
D)Amyotrophic lateral sclerosis

Question 19

Which statement(s)is/are true regarding Guillain-Barré syndrome?

A)It often follows on the heels of an upper respiratory viral infection
B)It is typically,but not exclusively,an ascending paralysis
C)High protein levels in the CSF can be diagnostic
D)All the above

Question 20

The respiratory complications arising from neuromuscular conditions follow which of these sequences?

A)Respiratory muscle compromise $\to$ decrease in lung volumes $\to$ tachypnea $\to$ dyspnea $\to$ poor cough $\to$ inability to express secretions $\to$ mucus plugging $\to$ atelectasis $\to$ pneumonia
B)Decrease in lung volumes $\to$ respiratory muscle compromise $\to$ dyspnea $\to$ tachpnea $\to$ inability to express secretions $\to$ poor cough $\to$ mucus plugging $\to$ pneumonia $\to$ atelectasis
C)Either sequence is possible
D)Neither sequence is correct

Question 21

Which of these specific treatment modalities is used to treat myasthenia gravis patients?

A)Plasmapheresis
B)Anticholinesterase medications
C)CPAP
D)Antibiotics

Question 22

Which of the following modalities is NOT useful in patients with neuromuscular disease?

A)Bronchial hygiene
B)Assisted cough
C)Incentive spirometry
D)IPPB

Question 23

What treatment may prove useful to the ALS patient who is struggling with ventilatory failure?

A)CPAP
B)Oxygen therapy by non-rebreathing mask
C)Ventilation at night with a body respirator
D)Intubation

Question 24

Which of the following clinical signs suggests the need for ventilatory assistance in the patient with neuromuscular disease?

A)Respiratory rate of 30/min
B)Progressive dyspnea
C)Vital capacity of 2.5 L
D)None of the above

Question 25

Which of these specific treatment modalities is NOT used to treat Guillain-Barré syndrome patients?

A)Plasmapheresis
B)Anticholinesterase drug
C)Mechanical ventilation
D)NIPPV

Question 26

What test or measurement is used to confirm the diagnosis of myasthenia gravis?

A)Spinal protein levels
B)Tensilon test
C)CT scans of the brain
D)Blood sedimentation rate

Question 27

Tracheostomy is most likely indicated in the neuromuscular patient with which of the following disorders?

A)Myasthenia gravis
B)T3 spinal injury
C)High cervical spine fracture
D)Guillain-Barré syndrome

Question 28

Which of these are true regarding myasthenia gravis?

A)There is an approximately 2 to 1 female to male ratio
B)It is typically a descending paralysis
C)It may be diagnosed using the Tensilon test
D)All the above