Neuro: Myasthenia Gravis & MS

Question 1

describe the bimodal distro of MG

Answer 1

20-40 (female)

60-90 (male)

Question 2

etiology of MG

Answer 2

autoimmune AChR attack

Question 3

2 hallmark sxs of MG

Answer 3

fluctuating fatigability & weakness

worse end of day or exercise

Question 4

what can be seen on CXR in MG…

Answer 4

thymoma

Question 5

Ptosis/diplopia occur in what percent of MG?

Answer 5

50%+

Question 6

Three drugs that worsen MG

Answer 6

FLQ
BBs
hydroxychloroquine

Question 7

patient cannot maintain upward gaze x 1 min

improved after cold pack admin

Answer 7

MG

Question 8

Diagnostic tests for MG

Answer 8

NCS & EMG

AChR Ab
MuSK Ab

CT Chest (thymoma)

Question 9

Sx tx for MG to improve strength

Answer 9

pyridostigmine (AChE Inhib)

Question 10

Chronic immunotherapies for MG

Answer 10

GCs, azathioprine

Question 11

Rapid immunomodulating agents

Answer 11

IVIG

plasmapheresis

Question 12

surgical intervention for MG

Answer 12

thymectomy (remission possible)

Question 13

who initiates tx of MG, what are 4 staples

Answer 13

neurology

1. sxs tx
2. chronic & rapid immunomodulators
3. surgery

Question 14

Imaging test of choice for MS

Answer 14

non-contrast MRI

Question 15

The hallmark of MS is sxs that occur in different _______ and ______

Answer 15

different time

affect different locations

Question 16

characteristic lesion on MRI for MS…

Answer 16

plaque

Question 17

What type of MS?

initial RR/episodic MS then progressive worsening

occurs after 10-20 years of MS

Answer 17

secondary progressive

Question 18

What type of MS?

progressive increase from onset, never remitting

Answer 18

primary progrssive

Question 19

MC initial feature of MS

Answer 19

paresthesia

Question 20

Young adult presents w. episodic hx of…

parasthesia
optic neuritis
weakness

Answer 20

MS

Question 21

transient worsening of sxs due to elevated body temp with MS…

Answer 21

uhthoff phenomenon

Question 22

assoc. w/ MS

neck flexion causes electrical shock sensation down back/limbs

Answer 22

lhermitte sign

Question 23

assoc. w/ MS

defective pupillary reaction to light

Answer 23

marcus gunn pupil

Question 24

Pt. p/w:

Visual loss
Motor disturbances

nystagmus
incoordination
tremor

hyperreflexia
(+) babinski
Clonus
(UMN signs)

Answer 24

MS

Question 25

1st line tx for RRMS

slow progression of disease

Answer 25

disease-modifying therapies

Question 26

1st line for MS exacerbation…

Answer 26

GCs (Methylprednisolone 1000mg IV QD x 5 days)

Question 27

What must be r/o to dx acute MS exacerbation

Answer 27

infx

Question 28

2 MS studies outside of MRI that can be helpful…

Answer 28

CSF analysis

evoked potential studies