Malignant Hyperthermia
Enjoy the MH QUIZ!
27 fun questions!

Directions: For each of the following questions or incomplete statements, ONE or MORE of the answers or completions given is correct. Click below on button
A if only 1, 2, and 3 are correct,
B if only 1 and 3 are correct,
C if only 2 and 4 are correct,
D if only 4 is correct,
E if all are correct.

1. Treatment of malignant hyperthemia includes
  1. dantrolene
  2. iced normal saline
  3. oxygen
  4. verapamil

2. Human malignant hyperthermia
  1. is usually inherited as an autosomal recessive trait
  2. can be caused by an abnormality of chromosome 19
  3. always causes fever and ridigity
  4. may present with masseter muscle spasm

3. Which of the following is/are true regarding skeletal muscle excitation-contraction:
  1. Muscle relaxation is an energy-dependent process.
  2. Myoplasmic calcium ion concentration increases with muscle relaxation.
  3. Troponin inhibits the actin-myosin contraction interaction.
  4. Calcium enhances troponin action.

4. Dantrolene
  1. decreases calcium ion release from sarcoplasmic reticulum.
  2. may alleviate chronic muscle spasticity.
  3. may lead to hepatic dysfunction during long-term administration.
  4. may cause severe hyperkalemia when used with verapamil.

5. Masseter muscle spasm may be
  1. avoided by pre-treating with a nondepolarizer before succinylcholine.
  2. an early sign of malignant hyperthemia.
  3. avoided by using an adequate dose of succinylcholine initially.
  4. avoided by avoiding succinylcholine.

6. Intraoperative events that correlate with the onset of a suspected malignant hyperthermic episode include
  1. progressive mixed acidosis.
  2. unexplained tachycardia.
  3. rising end-tidal pCO2 at fixed minute ventilation.
  4. hypokalemia.

7. Limitations affecting performance of testing for malignant hyperthermia (MH) include the
  1. need for fresh skeletal muscle.
  2. existence of multiple chromosome sites of the human genetic defect.
  3. need for testing known MH-susceptible individuals as controls.
  4. different international protocols for the halothane, caffeine contracture test.

8. Characteristics of malignant hyperthemia include
  1. autosomal dominant genetic transmission.
  2. association with central core myopathy.
  3. improved survival after the introduction of sodium dantrolene.
  4. triggering by local anesthetics.

DIRECTIONS: Each question below is followed by four suggested answers or completions. Select the one that is best in each case and click on the button containing the corresponding letter.

9. Incomplete jaw relaxation after halothane induction and succinylcholine administration in children is MOST likely

(A) a harbinger of malignant hyperthermia.
(B) due to an overdose of succinylcholine.
(C) found only in patients with atypical pseudocholinesterase.
(D) a normal response.

10. At preoperative evaluation, which of the following MOST strongly increases the probability of a subsequent intraoperative hyperthermic event?

(A) increased resting CPK concentrations
(B) history of temperature increase during general anesthesia
(C) familial history of an intraoperative hyperthemic event
(D) history of intraoperative muscle rigidity and hypercarbia with postoperative massively increased CPK concentrations

11. Which of the following is NOT a trigger for malignant hyperthermia?

(A) succinylcholine
(B) halothane
(C) sevoflurane
(D) ketamine

12. Which of the following is most clearly associated with malignant hyperthermia?

(A) central core disease
(B) bilateral strabismus
(C) myotonia congenita
(D) Down's syndome

13. Three year old boy with no other medical/surgical problems is scheduled for elective inguinal hernia repair. Birth weight 3.7 kg. First talked 13 months. First walked 17 months. NPO since midnight. Negative family history. Safe induction of anesthesia in this case should include

(A) a major inhalational agent plus nitrous oxide
(B) intravenous agents only
(C) avoidance of the combination of an inhaltion agent plus succinylcholine
(D) postponing case until neurological evaluation is done

14. Malignant hyperthermia triggers should be avoided in patients with each of the following EXCEPT?

(A) central core disease
(B) carnitine palmityl transferase deficiency
(C) neuroleptic malignant syndrome
(D) marked masseter muscle rigidity

DIRECTIONS: For each question below, select the one best choice, True or False, and click on the button containing the corresponding choice.

15. Malignant hyperthemia is inherited as an autosomal dominant trait in humans.

16. Low or normal ETCO2 would be unusual during an intraoperative episode of malignant hyperthermia.

17. Cocaine intoxication may mimic malignant hyperthermia.

18. Use of succinylcholine increases the risk of fulminant malignant hyperthemia by a factor of 3 to 4.

19. Excessive myoplasmic free calcium is the final common pathway to fulminant clinical malignant hyperthermia.

20. The ryanodine receptor is a lipid molecule.

21. Calcium channel blockers are useful adjuncts in treating malignant hyperthermia.

22. Licocaine can induce malignant hyperthermia.

23. No general anesthetic should be given without ready access to dantrolene.

24. MHAUS emergency telephone assistance is available 24 hours per day at 1-800-MH-HYPER (1-800-644-9737).

25. Ketamine triggers malignant hyperthermia.

26. Sevoflurane does not trigger malignant hyperthermia.

27. Central core disease is a myopathy strongly associated with malignant hyperthermia.

28. Relief of fever by dantrolene suggests that the fever was due to malignant hyperthermia.

29. It would be good judgment to stop triggering agents and give dantrolene, 3 mg/kg, IV, to an intraoperative patient with severe hypercarbia and marked combined acidosis despite apparent hyperpnea with tachypnea.

Greg Gordon MD