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NBME 21 Answers

nbme21/Block 2/Question#2 (42.8 difficulty score)
A 4-year-old girl is conscious but unable to ...
Pseudocholinesterase deficiencyπŸ”,πŸ“Ί

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submitted by haliburton(214),
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ragacha  THX +  

submitted by powerfulgarbage(13),

There was a uworld Q on this. The duration of action of Succinylcholine is determined by its metabolism by plasma cholinesterase. Some people are homozygous for an abnormal plasma cholinesterase, aka "pseudocholinesterase" or "butyrylcholinesterase" (BCHE). People with a homozygous BCHE mutation have delayed metabolism of succinylcholine, mivacurium, heroin, and cocaine.

In these patients, paralysis from succinylcholine can last for hours and you have to maintain them on mechanical ventilation until they can breath on their own

lovebug  2019FA 538pg. +  

submitted by d_holles(187),
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submitted by an_improved_me(16),

Might be a dumb question but... Can patients normally breathin on their own if givne succinylcholine?

trazobone  Yes! Normal people will have an adequate level of pseudocholinesterase to break down the succinylcholine and eventually cease its effects. But if your question is, will succinylcholine still inhibit breathing in a normal person, yes it will. It will work to paralyze muscles (like your diaphragm) in both a normal person and in someone with the pseudocholinesterase deficiency. The main issue is the ability to eventually break down the succinylcholine and come out of the paralysis +