Myasthenia Gravis

Question 1

What specifically does Myasthenia Gravis affect?
- what causes it to lead to paralysis?

Answer 1

Damages nicotinic receptors

can speed up the breakdown of acetylcholine
- can cause muscle weakness bc acetylcholine activates muscle contraction

Question 2

Define Myasthenia Gravis

Answer 2

chronic autoimmune neuromuscular disease that causes
- muscle weakness in skeletal muscles
- Improves after periods of rest
- Affect neuromuscaulr junction at postsynpatic level

Question 3

What are 2 clinical types of Myasthenia Gravis?

Answer 3

Ocular Myasthenia Gravis

generalized Myasthenia Gravis

Myastheninc crisis

Question 4

what is Seropositive myasthenia gravis?

Answer 4

when a pt has a detectable antibodies to nicotinic receptors (AChR) or muscle specific receptor tyrosine kinases (MuSK)

Question 5

Those who don’t have AChR and MuSK antibodies and receptors are categorized to have

Answer 5

Seronegative Myasthenia Gravis

Question 6

Why is the thymus gland relevant to Myasthenia Gravis?

Answer 6

The thymus is altered in pts w/Myasthenia Gravis.

• They have nicotinic receptor antibodies of anti-Ach receptor antibodies
• a thymectomy can be beneficial to those with seropositive Myasthenia Gravis

Question 7

what is a benefit of Edrophonium?

Answer 7

Prevents the breakdown of AcH

Question 8

Clinical manifestations of Myasthenia Gravis

Answer 8

descending paralysis and chronic muscle fatigue

• facial muscle weakness
• difficulty breathing, speaking, chewing
• unstable gate
• weakness in arms
• tendon reflex almost always intact

Question 9

what is ptosis

Answer 9

Drooping of one or both eyelids

Question 10

what is diploipia?

Answer 10

Double vision

Question 11

Clinical Manifestations;
Add slide 25 later PNS slide

Question 12

Screening and Diagnosis
slide 26 & 27

Question 13

What can you aspect for a RR for a pt w/Myasthenia Gravis?

Answer 13

Varying Resp. Rate (depending on lvl of paralysis)
- Diminished breath sounds
- Apnea
- early course crackles and/late fine inspiratory crackles

Question 14

signs of ventilatory failure from VC, NIF, pH, PaCO2

Answer 14

VC < 20ml/kg
NIF < -30cmH2O
pH <7.35
PaCO2 >45mmHg

Question 15

What does treatment typically aim to do for myasthenia gravis?

Answer 15

treat the targeting and underlying pathological immune response

i.e rapid immunotherapy

Question 16

First line of treatment for facilitating neuromuscular transmission?

Answer 16

Acetylcholinesterase inhibitors

Question 17

Treatments for myasthenia gravis that assist with immunosuppressive treatments and facilitation of neuromuscular transmissions?

Answer 17

• Acetylcholinesterase inhibitors
• Glucorticosteroids (chronic immunotherapy)
• Plaspheresis/IVIG (rapid immunotherapy)

Question 18

How could a Thyectomy assist with myasthenia gravis?

Answer 18

Thymus is the source of Anti-AcH receptor antibodies, removing could prevent the breakdown of AcH

• recommended for generalized myasthenia gravis

Question 19

What are general treatments myasthenia gravis?

Answer 19

Oxygen therapy (prevent hypoxemia)

Bronchial hygiene

lung expansion