MS/MG/ALS

Question 1

Chronic, progressive demyelination of the neurons in the CNS

Answer 1

MS

Question 2

sensory symptoms of MS

Answer 2

numbness, paresthesia, loss of proprioception, L’Hermitte’s sign

Question 3

motor symptoms of MS

Answer 3

spacticity, weakness

Question 4

cerebellar symptoms of MS

Answer 4

ataxia, dysarthria, slurred and scanning speech

Question 5

other symptoms of MS

Answer 5

vertigo, fatigue ,loss of vision, nystagmus, bowel/bladder disturbances, emotion and/or cognitive impairment

Question 6

what is one thing that can especially trigger symptoms

Answer 6

hot temperature

Question 7

which drug can you only give a approved facility due to leukoencephalopathy

Answer 7

natalizumab (Tysabril) - it is a monoclonal antibody

Question 8

which drugs do you need to give a GI protectant with

Answer 8

glucocorticoid:methylprednisonolone (the “Medrols”)

Question 9

drugs that treat spasticity

Answer 9

baclofen and baclofen pump, clonazepam and diazepam (valium), tizanidine and gabapentin, botulinlum toxin

Question 10

mneumonic

Answer 10

D-Diploplia
E-Eye movement painful
M-Motor: weakness and spasticity
Y-nYstagmus
E-Elevated temperature
L-Lhermitte’s phenomenon
N-Neuropathic pain
A-Ataxia
T-Talking slurred
I-Impotence
O-Overactive bladder
N-Numbness

Question 11

autoimmune neuromuscular disorder where acetylcholine receptors at the neuromuscular junction are destroyed.

Answer 11

Myasthenia Gravis

Question 12

autoimmune disorder that gets worse with activity and better at rest. thymus gland abnormalities and extra ocular muscles affected first

Answer 12

MG

Question 13

trigger to worsening MG symptoms

Answer 13

sunlight, viral illness surgery, immunizations, emotional stress, menstruation, gets worse at the end of the day

Question 14

first symptoms are ptosis (droopy eyes) and diplopia (double vision)

Answer 14

MG

Question 15

progression of the disease leads to worsening of symptoms and decreased symptom free periods

Answer 15

MG

Question 16

what is myasthenia crisis

Answer 16

caused by UNDER medication. (Lack of acetylcholine) or stressors such as infection, surgery, or incompatible meds. Symptom include worsening muscle weakness, SOB, and difficulty swallowing or talking

Question 17

what is cholinergic crisis in MG

Answer 17

Overmedication. Overdose of anti cholinesterase, excess acetylcholine. Symptoms include muscle weakness, cramps, difficulty talking and swallowing, bradycardia, bronchospasm, excessive salivation, lacrimation, vomiting, diarrhea, excessive swallowing, fasciculations (involuntary muscle twitches.)

Question 18

prevents the breakdown of acetylcholine by competitively inhibiting acetylcholinesterase at the neuromuscular junction

Answer 18

Tensilon

Question 19

what is the antidote for Tensilon

Answer 19

atropine

Question 20

prevents the breakdown of acetylcholine at the neuromuscular junction (destroys cholinesterase that is destroying acetylcholine)

Answer 20

Cholinesterase inhibitors: neostigmine, pyridostigmine, ambenonium

Question 21

which cholinesterase inhibitor has the least side effects

Answer 21

pyridostigmine. abdominal cramping, diarrhea, increased peristalsis, increased salivation, bradycardia, blurred vision

Question 22

what can be used in MG when cholinesterase inhibitors are ineffective?

Answer 22

immunotherapy: corticosteroids, azathioprine, and cyclosporine

Question 23

MG assessment “BRISH”

Answer 23

B-Bowel and bladder dysfunction
R-Risk of respiratory failure
I-Increased pulse, respirations, and BP
S-Sudden severe motor weakness
H-Hypoxia and cyanosis