Myasthenia Gravis

Question 1

Myasthenia Gravis is a(n)…

Answer 1

acquired, autoimmune, progressive disease

Question 2

Myasthenia Gravis is characterized by?

Answer 2

Muscle weakness

Question 3

Myasthenia Gravis has remissions and exacerbations? True or false?

Answer 3

True

Question 4

What causes flares in MG?

Answer 4

Emotional stress, pregnancy, illness, heat

Question 5

MG peaks within ____ years of diagnosis?

Answer 5

2 years

Question 6

MG Is a result of…

Answer 6

reduction of acetylcholine receptors

Question 7

Severity varies from what to what?

Answer 7

Mild motor neuron disturbances to respiratory failure

Question 8

MG typically originates where?

Answer 8

Face, jaw, and neck

Question 9

What parts of the body are later affected?

Answer 9

Arms and legs

Question 10

What are the two types of MG?

Answer 10

Ocular

Generalized

Question 11

What are the ocular symptoms of MG?

Answer 11

Ptosis

Diplopia

Question 12

What is ptosis?

Answer 12

Droopy eyes, can be uni/bilateral, can switch eyes

Question 13

What is diplopia?

Answer 13

Double vision

Question 14

What are bulbar symptoms of MG?

Answer 14

Dysarthria
Dysphagia
Fatigable chewing

Question 15

What is dysarthria?

Answer 15

“Marbled” speech

Question 16

Diagnosis of MG depends on….

Answer 16

ocular or general symptoms

Question 17

What are the tests to diagnose MG?

Answer 17

Tensilon Test
Ice Pack Test
Serologic Test- Autoantibodies
Nerve conduction test (EMG)

Question 18

Explain tensilon test…

Answer 18

Tensilon is an acetylcholinesterase inhibitor that is given IV; onset is 30-45 seconds, duration of action is 5-10 minutes; watch the eyelids, ptosis will improve if MG

Question 19

Explain ice pack test…

Answer 19

surgical glove filled with ice is placed on eyelid(s) for 2 minutes; when ice is removed, ptosis will immediately improve if MG

Question 20

Which antibodies does the serologic test show?

Answer 20

Acetylcholine receptor (AChR-Ab) antibodies
Muscle-specific tyramine kinase (MuSK) antibodies

Question 21

Drug therapy for MG

Answer 21

Acetylcholinesterase inhibitors
     >first line treatment
     >pyridostigmine bromide
Immunotherapeutics
     >predisone
     >azathioprine
     >cyclosporine

Question 22

Short term treatments are used…

Answer 22

until other medications take effect
prior to surgery
for myasthenic crisis

Question 23

What are the short term treatments for MG?

Answer 23

Intravenous immunoglobulin (IVIG)
Plasmapheresis (plasma exchange)

Question 24

What is intravenous immunoglobulin (IVIG)?

Answer 24

Injection of nonspecific antibody (immunoglobulin) that dials down the immune system’s production of its own antibodies

Question 25

What is plasmapheresis?

Answer 25

Plasma exchange; antibodies are removed from plasma to decrease symptoms; 6 exchanges over a 2-week period

Question 26

MG Surgical Management

Answer 26

Thymectomy- removal of thymus (thymus enhances AChR antibodies); done early in diagnosis

Question 27

Hospital admissions for MG are related to…

Answer 27

respiratory tract infection

acute myasthenic crisis

Question 28

Teach:

Answer 28

Balanced diet (semi-solid is best)
What causes flairs
Medicine regimen
Complications of MG
Complications of therapy
Support groups available

Question 29

Difference between myasthenic crisis and cholinergic crisis?

Answer 29

Myasthenic crisis:
> Caused by NOT ENOUGH anticholinesterase drugs or some type of infection
Cholinergic Crisis
> Caused by TOO MANY anticholinesterase drugs

Question 30

Features common to both myasthenic crisis and cholinergic crisis?

Answer 30

Apprehension
Restlessness
Dyspnea
Dysphagia
Generalized weakness
Respiratory failure

Question 31

Unique features of myasthenic crisis?

Answer 31

Increase in VS
Bowel/ bladder incontinence
Absence of cough/ swallow reflex
Improvement of symptoms with tensilon test

Question 32

Unique features of cholinergic crisis?

Answer 32

Flaccid paralysis
Hypersecretions (saliva, sweat, tears)
N/V/D
Abdominal cramps
Worsening symptoms with tensilon test