Final Exam NR574
1. What are com- Trauma, muscle compression, or ischemia
mon trauma-re-
lated risk factors
for Rhabdomyol-
ysis?
2. What are ex- Compartment syndrome, crush injuries, lightning strike, near-drowning, signifi-
amples of trau- cant burns, blunt force trauma, high-voltage electrical injuries, prolonged immo-
ma-related caus- bilization following a fall
es of Rhabdomy-
olysis?
3. What heat-relat- Heatstroke, malignant hyperthermia, and neuroleptic malignant syndrome
ed conditions can
lead to Rhab-
domyolysis?
4. What infections Epstein-Barr virus (EBV), cytomegalovirus (CMV), adenovirus, human immunod-
can directly at- eficiency virus (HIV), coxsackievirus, influenza A/B, herpes simplex virus (HSV),
tack muscle and Varicella-zoster virus (VZV), E. Coli, C. perfringens, Legionella, Rickettsia, Group B
cause Rhab- beta-hemolytic streptococci, S. pneumoniae, S. pyogenes
domyolysis?
5. What metabolic Electrolyte imbalances (hypocalcemia, hypophosphatemia, hypokalemia,
factors can con- hypo-and hypernatremia), hypothyroidism, hyperglycemic hyperosmolar nonke-
tribute to Rhab- totic syndrome
domyolysis?
6. Rhabdomylosis Genetic factors Phosphofructokinase deficiency, myoadenylate deaminase defi-
risk factors ciency phosphoglycerate kinase deficiency, mitochondrial respiratory chain en-
zyme deficiencies, sickle cell trait, etc.
Medications that may cause direct myotoxicity
, Final Exam NR574
HMG-CoA reductase inhibitors, cyclosporin, corticosteroids, zidovudine,
colchicine, itraconazole
Toxins which may cause indirect myotoxicity
CNS depressants, alcohol, heroin, cocaine, ethanol, ketamine, barbiturates, am-
phetamines, caffeine, neuromuscular blocking agents, ecstasy, carbon monoxide,
snake, or spider venom, etc.
Exertional activity
Marathons, high-intensity interval training, intense repetitive physical activity es-
pecially in untrained people, activities causing dehydration or performed in hot
or humid conditions
Nutritional supplements which contain substances that may induce muscle in-
juryEphedra, creatine, or large doses of caffeine
7. Clinical presenta- Classic clinical findings characteristic of rhabdomyolysis includes dark urine,
tion of Rhabdo muscle pain, and muscle weakness. However, myoglobin is rapidly excreted and
(subjective) metabolized to bilirubin (half-life 2-3 hours) so visible changes in the urine may
no longer be observable by the time the client seeks care.
8. Physical exam Physical exam findings in clients with rhabdomyolysis may also include:
finidings of Rhab- muscle tenderness
do soft tissue swelling
bruising
skin changes consistent with pressure necrosis
muscle weakness
confusion, delirium, agitation
anuria
9. How do you diag- dark urine, acute neuromuscluar illness without other symptoms PLUS acute
nose Rhabdo elevation in serum creatinine kinase (typically 5x the upper limit of normal)
, Final Exam NR574
10. what is the most CK
reliable lab for it will be markely elevated >1000
Rhabdo? normal level is 45-260
11. Ck levels in rhab- it begins to rise within 2-12 hours , peaks around 24-72 hrs following the injury.
do? then the levels decline 3-5 days of muscle injury cessation.
SERUM CK > 5,000 results in AKI
12. what test as- MRI
sesses the extent
of injury to the
muscles?
13. Complications Compartment syndrome is suspected in when CK levels continue to rise or fail to
for RHabdo? decline following the inciting event. compartment pressures should be measured.
14. TX of Rhabdo? Fluids at least 400ml/hr to prevent AKI to maintain a UOP of at least 200ml/hr
in patients who CK levels are greater than 15,000 6L of IVF is required
15. what electrolyte Hypocalcemia - - not clinically signifant unless in a dysrhythmia
imbalance are
rhabdo patients Hyperkalemia - - Dextrose, sodium bicarb, sodium polystyrene sulfonate , some-
at risk for? times HD
Hyperurecemia & Hyperphosphate usually dont require tx
16. Tx of rhabdo (2) monitor for DIC, renal failure, seizure, ekg changes, hyperkalemia
17. acute Intestinal Adhesions from previous abdominal surgery
obstruction risk Internal or external hernias
factors Foreign bodies
Feces
, Final Exam NR574
Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and
malrotation)
Trauma (hematoma formation)
Inflammation (inflammatory bowel disease, diverticulitis, radiation, and tubercu-
losis)
Neoplasms including carcinomatosis, colon cancer, primary small bowel cancer,
and extraintestinal malignancies such as ovarian cancer
Endometriosis
Volvulus
Ischemic injury
Intussusception
Intraperitoneal abscess
18. How will the pa- The most common presenting symptoms of acute intestinal obstruction include:
tient present in colicky abdominal pain (cramping periumbilical pain initially; later becomes con-
acute intestinal stant and diffuse)
obstruction? abdominal pain often more severe with distal obstruction
vomiting (more significant with proximal obstruction)
abdominal bloating
obstipation
History should include essential elements such as previous abdominal or pelvic
surgeries, comorbid conditions such as inflammatory bowel disease or malignan-
cy.
19. Key physical Clients presenting with acute intestinal obstruction can often be critically ill. Key
exam / clini- physical exam findings may include:
cal findings in Fever (systemic inflammation or strangulation)
acute intestinal
obstruction? High-pitched, tinkling, bowel sounds (may be hypoactive or absent with complete
obstruction)
Abdominal distention (more significant with distal obstruction due to the greater
1. What are com- Trauma, muscle compression, or ischemia
mon trauma-re-
lated risk factors
for Rhabdomyol-
ysis?
2. What are ex- Compartment syndrome, crush injuries, lightning strike, near-drowning, signifi-
amples of trau- cant burns, blunt force trauma, high-voltage electrical injuries, prolonged immo-
ma-related caus- bilization following a fall
es of Rhabdomy-
olysis?
3. What heat-relat- Heatstroke, malignant hyperthermia, and neuroleptic malignant syndrome
ed conditions can
lead to Rhab-
domyolysis?
4. What infections Epstein-Barr virus (EBV), cytomegalovirus (CMV), adenovirus, human immunod-
can directly at- eficiency virus (HIV), coxsackievirus, influenza A/B, herpes simplex virus (HSV),
tack muscle and Varicella-zoster virus (VZV), E. Coli, C. perfringens, Legionella, Rickettsia, Group B
cause Rhab- beta-hemolytic streptococci, S. pneumoniae, S. pyogenes
domyolysis?
5. What metabolic Electrolyte imbalances (hypocalcemia, hypophosphatemia, hypokalemia,
factors can con- hypo-and hypernatremia), hypothyroidism, hyperglycemic hyperosmolar nonke-
tribute to Rhab- totic syndrome
domyolysis?
6. Rhabdomylosis Genetic factors Phosphofructokinase deficiency, myoadenylate deaminase defi-
risk factors ciency phosphoglycerate kinase deficiency, mitochondrial respiratory chain en-
zyme deficiencies, sickle cell trait, etc.
Medications that may cause direct myotoxicity
, Final Exam NR574
HMG-CoA reductase inhibitors, cyclosporin, corticosteroids, zidovudine,
colchicine, itraconazole
Toxins which may cause indirect myotoxicity
CNS depressants, alcohol, heroin, cocaine, ethanol, ketamine, barbiturates, am-
phetamines, caffeine, neuromuscular blocking agents, ecstasy, carbon monoxide,
snake, or spider venom, etc.
Exertional activity
Marathons, high-intensity interval training, intense repetitive physical activity es-
pecially in untrained people, activities causing dehydration or performed in hot
or humid conditions
Nutritional supplements which contain substances that may induce muscle in-
juryEphedra, creatine, or large doses of caffeine
7. Clinical presenta- Classic clinical findings characteristic of rhabdomyolysis includes dark urine,
tion of Rhabdo muscle pain, and muscle weakness. However, myoglobin is rapidly excreted and
(subjective) metabolized to bilirubin (half-life 2-3 hours) so visible changes in the urine may
no longer be observable by the time the client seeks care.
8. Physical exam Physical exam findings in clients with rhabdomyolysis may also include:
finidings of Rhab- muscle tenderness
do soft tissue swelling
bruising
skin changes consistent with pressure necrosis
muscle weakness
confusion, delirium, agitation
anuria
9. How do you diag- dark urine, acute neuromuscluar illness without other symptoms PLUS acute
nose Rhabdo elevation in serum creatinine kinase (typically 5x the upper limit of normal)
, Final Exam NR574
10. what is the most CK
reliable lab for it will be markely elevated >1000
Rhabdo? normal level is 45-260
11. Ck levels in rhab- it begins to rise within 2-12 hours , peaks around 24-72 hrs following the injury.
do? then the levels decline 3-5 days of muscle injury cessation.
SERUM CK > 5,000 results in AKI
12. what test as- MRI
sesses the extent
of injury to the
muscles?
13. Complications Compartment syndrome is suspected in when CK levels continue to rise or fail to
for RHabdo? decline following the inciting event. compartment pressures should be measured.
14. TX of Rhabdo? Fluids at least 400ml/hr to prevent AKI to maintain a UOP of at least 200ml/hr
in patients who CK levels are greater than 15,000 6L of IVF is required
15. what electrolyte Hypocalcemia - - not clinically signifant unless in a dysrhythmia
imbalance are
rhabdo patients Hyperkalemia - - Dextrose, sodium bicarb, sodium polystyrene sulfonate , some-
at risk for? times HD
Hyperurecemia & Hyperphosphate usually dont require tx
16. Tx of rhabdo (2) monitor for DIC, renal failure, seizure, ekg changes, hyperkalemia
17. acute Intestinal Adhesions from previous abdominal surgery
obstruction risk Internal or external hernias
factors Foreign bodies
Feces
, Final Exam NR574
Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and
malrotation)
Trauma (hematoma formation)
Inflammation (inflammatory bowel disease, diverticulitis, radiation, and tubercu-
losis)
Neoplasms including carcinomatosis, colon cancer, primary small bowel cancer,
and extraintestinal malignancies such as ovarian cancer
Endometriosis
Volvulus
Ischemic injury
Intussusception
Intraperitoneal abscess
18. How will the pa- The most common presenting symptoms of acute intestinal obstruction include:
tient present in colicky abdominal pain (cramping periumbilical pain initially; later becomes con-
acute intestinal stant and diffuse)
obstruction? abdominal pain often more severe with distal obstruction
vomiting (more significant with proximal obstruction)
abdominal bloating
obstipation
History should include essential elements such as previous abdominal or pelvic
surgeries, comorbid conditions such as inflammatory bowel disease or malignan-
cy.
19. Key physical Clients presenting with acute intestinal obstruction can often be critically ill. Key
exam / clini- physical exam findings may include:
cal findings in Fever (systemic inflammation or strangulation)
acute intestinal
obstruction? High-pitched, tinkling, bowel sounds (may be hypoactive or absent with complete
obstruction)
Abdominal distention (more significant with distal obstruction due to the greater
