amk day teach

Question 1

what drug causes myasthenia gravis

Answer 1

bisprolol

Question 2

myasthenia gravis - young females and older men - autoantibodies against postsynaptic acetylcholine receptor ACHR - so can’t stimulate as few receptors so harder to get impulse - muscle weakness during periods of activity and early signs are ptosis and diplopia at the end of the day after periods of rest
facial paresis - snarl as can’t get mouth up,
things wrong with their thymus too - thymus
IX and Tx

Answer 2

Ix - serum acetylcholine repotor antibody
CT chest ofr thymus
ice pack test - over eye lid and ice freezes the enzyme which improves the ptosis

1st line is pyridostigmine 9 BLOCKS ESTERASE ENZYME which then allows more of the substrate to work
IgG immunoglobulins
predisnisolone for immunosuppression or cyclosporine

thymecotym - can be curative

Question 3

Lambert eaton starts at legs and goes up and affects the eyes affect the calcium channels - get it with small cell carcinoma in the lung

Answer 3

use muscles more in Lambert Eton it gets better

Question 4

drugs to avoid in MG

Answer 4

peniclliamine ( Wilsons disease) 
beta blockers 
lithium - bipolar 
phenytoin 
antibiotics such as  macrocodes, gentamicin, quinolone, tetracycline 
quindide and procainamide

Question 5

mS is denotative codtion of CNS which causes demyelination and axonal degeneration and has high prevalence in women

take vit D to reduce risk

cicnail features
include optic neuritis - feels like looking through vasalne, colour blidnles and pain on moovin g
opthalmolpelgiia

trig menial neuralgia - big sign
shooting sensation down the spine after flexion of the neck

spastic weakesns

ataxia and intention tremor

UI and fatigue

nystagmus , difficult talking and intention tremour

diagnosis is flair sequence on MRI of brain and spine
slecortic plaques

Tx is what

Answer 5

acute relapse Is high dose steroids 0 oral or IV ethlyprednisplone

beta inferon

gabapentin and baclofen( spasticity)

uhthoff penomen - if overheated symptoms get worse and resolve once cool down but not release

EBV and MS link

Question 6

Huntington’s repeat is CAG trinucelotide- autosomal dominant repeat and MRI will show

Answer 6

atrophy of the caudate nucleus and putamen

Question 7

Sx of Huntington’s

Answer 7

early signs are memory loss and low mode and develop and the movement disorder presents later

Question 8

anticipation defintion in the context of a neurological disorder

Answer 8

every successive generation symptoms are worse

Question 9

repeats

Answer 9

less than 27 fine
-35 risk to childrn e
39 - positive with smtposm at older age
40 and over risk to children and risk of getting it younger

Question 10

IX of huntigntons
CAG repeat over 38
CT or MRI in later stages can show atrophy of caudate nucleus

tx

Answer 10

chorea - tetrabenazine and dopamine
rigidity and bradykinease - l-dopa
depression - SSRI
hallucinations dn delusion - anti-psychotics

Question 11

parkinsons - progressive nruodegentrative condtion susbtrntia nigra - 65 years

Answer 11

bradykinesia, tremor, rigidity
flexed posture and mask like face , drooling , psychiatric features - depression is the most common feature and sleep disturbancew , impaired olfaction and autonomic dysfunction

Question 12

first signs of PD

Answer 12

constipation - levy bodies begin in bowel then go to brain

always ask about sleeping arrangement
depression

ED and olfactory loss and hypotension

Question 13

management of Parkinson

Answer 13

l-dopa if sytmpsom affecting life

not affecting life then MAO-b inhibitors or dopamine agonists

Question 14

Parkinson drugs cause gambling

Answer 14

rasagiline - dopamine agonists

Question 15

most common clinical course of MS

Answer 15

relapsing remitting MS