Myasthenia Gravis

Question 1

Myasthenia gravis

Answer 1

Acquired, autoimmune, progressive disease characterized by muscle weakness. Times of remission and exacerbations. Results from reduction of acetylcholine receptors

Question 2

What are some stressors that can cause flares

Answer 2

Emotional stress, pregnancy, illness, heat

Question 3

What is the worst outcome that could occur due to myasthenia gravis

Answer 3

Leads to respiratory failure secondary to muscle weakness

Question 4

What are the two types of MG

Answer 4

Ocular, which occurs around face and neck. And generalized

Question 5

Ptosis

Answer 5

Drooping eyelid, occurs 50% of the time

Question 6

Diplopia

Answer 6

Double vision, occurs in 50%

Question 7

Dysarthria

Answer 7

Garbled speech

Question 8

Dysphagia

Answer 8

Trouble swallowing, concern for aspiration

Question 9

What are the three bulbar symptoms that can occur

Answer 9

Dysarthria, dysphasia, fatigable chewing

Question 10

What are two bedside tests that are used in the diagnosis of MG

Answer 10

1. Tension test: onset 30-45 seconds, duration of action 5-10 minutes, give IV, watch eyelids, ptosis will improve if it is MG
2. Ice pack test: ice on eyelid for two minutes, remove ice, immediately asses ptosis, will improve if MG

Question 11

What are two serological test of auto antibodies you can use in the diagnosis of MG

Answer 11

Seda: receptor antibodies, muscle specific tyramine kinase antibodies

AChR-Ab and MuSK

Question 12

A nerve conduction test or EMG can be used to diagnose what

Answer 12

MG

Question 13

Drug therapy of patient with myasthenia gravis

Answer 13

Acetylcholinestrase inhibitors (first line)
Immunotheraputics

Question 14

Short term drug therapy for MG patience

Answer 14

Usually ordered Until other Other medication to take affect, prior to surgery, myasthenia crisis

1. IV immunoglobulin
2. Plasmapheresis

Question 15

Thymectomy

Answer 15

Done for MG because thymus gland seems to enhance AChR antibodies

Question 16

When would a thymectomy be done?

Answer 16

Early in Mg Dx, within two years

Question 17

Care of a patient with MG

Answer 17

Focus on care of neurological deficits and their impact on a DL, teach balanced diet that can be easily chewed and swallowed, schedule meds so peak action is during meal time, arrange diversion activities that require minimal exertion,

Question 18

What kind of meals are easily chewed and swallowed, a.k.a. the best texture for a patient with MG

Answer 18

Semi solid

Question 19

Teaching

Answer 19

Teach Causes flares, medication and its potential side effects, complications of disease, complications of therapy such as crisis conditions, support group availability, important to know the difference between cholinergic crisis and my aesthetic crisis

Question 20

Myasthenia crisis

Answer 20

Caused by not enough anticholinesterase drugs

Question 21

Cholinergic crisis

Answer 21

Caused by too many anticholineresterase drugs

Question 22

What are common features of both myasthenia crisis and cholinergic crisis

Answer 22

Apprehension, restlessness, dyspnea, dysphasia, generalized weakness, respiratory failure

Question 23

Unique features of myasthenia crisis

Answer 23

Increase in vital signs, incontinence, absence of cough or swallow reflux, improvement of symptoms with Tensilon test

Question 24

Unique features of a cholinergic crisis

Answer 24

Are flaccid paralysis, hypersecretion such a saliva sweat and tears, nausea, vomiting, diarrhea, abdominal cramps, worsening symptoms with the tensilon test