Reversing Neuromuscular Blockage! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-10-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 151
Threads: 39
Thanked 52 Times in 29 Posts
Reputation: 62
Anesthesiology Reversing Neuromuscular Blockage!

A middle aged female undergoing cholecystectomy after recovering from anesthesia is found to have pulse of 28/min. Which of the following is the drug of choice to reverse neuromuscular blockage?

A. Direct muscarinic agonist
B. Anticholinesterase only
C. Anticholinesterase + muscarinic ahtagonist
D. Cholinesterase regenerator
E. Anticholinesterase + Cholinesterase regenrator
Reply With Quote Quick reply to this message
The above post was thanked by:
DocSikorski (09-11-2011), usluipek (09-10-2011), usmle2011 (09-10-2011)



  #2  
Old 09-10-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,259 Times in 881 Posts
Reputation: 3269
Default

first atropine!!!....then neostigmine...
Reply With Quote Quick reply to this message
  #3  
Old 09-10-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 512
Threads: 57
Thanked 318 Times in 163 Posts
Reputation: 328
Default

i will go with C
Reply With Quote Quick reply to this message
  #4  
Old 09-10-2011
usmledr's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 22
Threads: 7
Thanked 2 Times in 2 Posts
Reputation: 12
Default

Yes..C...similar qs in NBME 5
Reply With Quote Quick reply to this message
  #5  
Old 09-11-2011
laurier's Avatar
USMLE Forums Addict
 
Steps History: CK Only
Posts: 105
Threads: 19
Thanked 69 Times in 32 Posts
Reputation: 79
Default

can you explain plz the answer
Reply With Quote Quick reply to this message
  #6  
Old 09-11-2011
yasirsattar75's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 395
Threads: 51
Thanked 292 Times in 111 Posts
Reputation: 302
Default

i think its D coz cholinesterase regenerators like oximes are useful in reversing neuromuscular blockade .....
__________________
study study till ur brain is saturated
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #7  
Old 09-11-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,259 Times in 881 Posts
Reputation: 3269
Default

Quote:
Originally Posted by laurier View Post
can you explain plz the answer
"A middle aged female undergoing cholecystectomy after recovering from anesthesia is found to have pulse of 28/min. Which of the following is the drug of choice to reverse neuromuscular blockage?"

Assuming that the patient has a residual effect of an neuromuscular blocking drug (such as rocuronium), in this particular case first you must use atropine (HR 28x/min)...and after reaching a HR > 50-60 x/min, you can start using an anticholinesterase drug (neostigmine).
Reply With Quote Quick reply to this message
The above post was thanked by:
drfchakera (09-13-2011), laurier (09-11-2011)
  #8  
Old 09-11-2011
pass7's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 406
Threads: 30
Thanked 140 Times in 108 Posts
Reputation: 150
Default

C. Anticholinesterase + muscarinic ahtagonist
Reply With Quote Quick reply to this message
  #9  
Old 09-11-2011
laurier's Avatar
USMLE Forums Addict
 
Steps History: CK Only
Posts: 105
Threads: 19
Thanked 69 Times in 32 Posts
Reputation: 79
Default

@bebix: thank you for your explanation,
but you are assuming curarium has been used, but these drugs has no effect in cardiaque muscle, so how do you explain the bradycardia?
Reply With Quote Quick reply to this message
  #10  
Old 09-11-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,259 Times in 881 Posts
Reputation: 3269
Default

Quote:
Originally Posted by laurier View Post
@bebix: thank you for your explanation,
but you are assuming curarium has been used, but these drugs has no effect in cardiaque muscle, so how do you explain the bradycardia?
" these drugs has no effect in cardiaque muscle" really?
- nondepolarizing neuromuscular blocking agents (except vecuronium) = increase HR.

in any case, they are multiple causes of bradycardia at the end of the surgery...
- use of neostigmine before atropine...this is a classic!
- Hypoventilation and hypoxia
- vagal reflex
- TIVA with remifentanil + propofol
...and the list goes on...
Reply With Quote Quick reply to this message
  #11  
Old 09-12-2011
laurier's Avatar
USMLE Forums Addict
 
Steps History: CK Only
Posts: 105
Threads: 19
Thanked 69 Times in 32 Posts
Reputation: 79
Default

thank you bebix for clarifying this
Reply With Quote Quick reply to this message
  #12  
Old 09-13-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 55
Threads: 21
Thanked 10 Times in 10 Posts
Default

Quote:
Originally Posted by bebix View Post
"A middle aged female undergoing cholecystectomy after recovering from anesthesia is found to have pulse of 28/min. Which of the following is the drug of choice to reverse neuromuscular blockage?"

Assuming that the patient has a residual effect of an neuromuscular blocking drug (such as rocuronium), in this particular case first you must use atropine (HR 28x/min)...and after reaching a HR > 50-60 x/min, you can start using an anticholinesterase drug (neostigmine).
Then the answer is C?
Reply With Quote Quick reply to this message



Reply

Tags
Pharmacology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)