Myasthenia Gravis Flashcards
Myasthenia gravis is a condition affecting the neuromuscular junction of skeletal muscles. What is the cause of this disease?
1 - idiopathic
2 - autoimmune
3 - metabolic
4 - vascular
2 - autoimmune
- autoantibodies target nicotinic acetylcholine receptors on post synapse
- B and T cells are involved
What is the prevalence of myasthenia gravis?
1 - 1.5-36.7 cases per 100,000
2 - 105-360 cases per 100,000
3 - 1500-3600 cases per 100,000
4 - 15,00-36,000 cases per 100,000
1 - 1.5-36.7 cases per 100,000
- this is a rare condition
Are men or women more at risk of myasthenia gravis?
- women
- typically aged 20-30 y/o
What type of hypersensitivity is myasthenia gravis classified as?
1 - type 1 hypersensitivity
2 - type 2 hypersensitivity
3 - type 3 hypersensitivity
4 - type 4 hypersensitivity
2 - type 2 hypersensitivity
- also called cytotoxic hypersensitivity
- T cells and complement pathway lead to cell damage, inflammation and apoptosis
In myasthenia gravis is it just the acetylcholine receptors on the post synapse that are affected?
- no
- some patients produce another antibody that can enter skeletal muscle leading to apoptosis of skeletal muscle cells
In myasthenia gravis the acetylcholine receptors on the post synapse or skeletal muscle cells can be damaged, inducing apoptosis due to autoantibodies. What has also been identified as a cause of myasthenia gravis?
1 - alcohol
2 - smoking
3 - metabolic syndrome
4 - paraneoplastic syndrome
4 - paraneoplastic syndrome
- bronchiogenic carcinoma or thymic neoplasm are most common causes
- malignancy induces and immune response and auto-antibodies, which subsequently targets the NMJ
Myasthenia gravis can present with all of the following, but which is the tell tale sign?
1 - ptosis
2 - muscular weakness with fatigue
3 - bulbar (swallowing, chewing)
4 - facial/neck weakness
5 - limb girdle and trunk
2 - muscular weakness with fatigue
- exhausted in the evenings
Which of the following are clinical signs of myasthenia gravis?
1 - dysphonia upon counting (slurred)
2 - ptosis and diplopia (double vision)
3 - myasthenia snarl when smiling
4 - peak signs of orbicularis (eyes opening despite you closing them)
5 - general weakness
6 - all of the above
6 - all of the above
Although any skeletal muscles can be affected, which is often the most common?
1 - muscles of hands
2 - extra-ocular muscles
3 - respiratory muscles
4 - cardiac muscles
2 - extra-ocular muscles
- common to see ptosis (dropping) and diplopia (double vision)
There are some common exacerbating factors of myasthenia gravis. Which of the following is NOT one of these?
1 - pregnancy
2 - low Na+
3 - exercise
4 - gentamicin
5 - beta blockers
6 - opiates
2 - low Na+
- low K+ can make patients worse
- the rest of these medications can act as neuromuscular blockade and make myasthenia gravis symptoms worse
All of the following are typical differentials for myasthenia gravis, EXCEPt which one?
1 - polymyositis
2 - myopathies
3 - connective tissue disorders (SLE)
4 - stroke
5 - botulism
6 - Lambert-Eaton myasthenic syndrome
4 - stroke
Patients who are suspected of having myasthenia gravis should be screened for ermatomyositis, polymyositis, systemic lupus erythematosus, Addison’s disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. What do all of these have in common?
1 - higher incidence in women
2 - occur at a younger age
3 - all autoimmune disease
4 - all of the above
3 - all autoimmune disease
Which of the following is NOT a typically used test when trying to diagnose a patient with myasthenia gravis?
1 - ACh antibodies
2 - CK-MB
3 - EMG (decremental muscle response)
4 - CT to exclude malignancy (thyoma or bronchiogenic carcinoma)
5 - thyroid function
2 - CK-MB
Can myasthenia gravis be dangerous and a risk to life?
- yes
- myasthenia crisis
- respiratory and/or cardiac depression
What is the typical 1st line medication for patients with myasthenia gravis?
1 - Acetylcholinesterase inhibitors
2 - NMDA receptor antagonist
3 - Dopamine agonist
4 - Anticholinergics
1 - Acetylcholinesterase inhibitors
- increase ACh in synaptic cleft
- core drug for is Donepezil
- drug referenced in lecture was Pyridostigmine