Neuromuscular Junction Flashcards

1
Q

what is the motor end plate

A

synapses between motor neurons and muscles

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2
Q

what neurotransmitter is released from motor neurones

A

acetyl choline

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3
Q

what triggers release of acetyl choline from motor neurones

A

opening of voltage gated calcium channels (Ca influx)

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4
Q

effect of acetyl choline on muscle cells

A

makes the membrane permeable to Na/K ions starting action potential

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5
Q

effect of acetylcholinesterase

A

breaks down acetyl choline to acetate and choline

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6
Q

what is lambert eaton myasthenic syndrome

A

antibodies to presynaptic calcium channels

means less acetyl choline vesicle production and release

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7
Q

what condition is lambert eaton myasthenic syndrome strongly associated with

A

small cell carcinoma

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8
Q

what is the most common disorder of the neuromuscular junction

A

myasthenia gravis

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9
Q

what is myasthenia gravis

A

autoimmune antibodies to post-synaptic acetyl choline receptors
reduced numberof functioning receptors leading to muscle weakness and fatigue

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10
Q

Transmission improves with increased amount of acetyl choline in myasthenia gravis. True/false

A

False

even with normal amounts of Ach, transmission becomes ineffective

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11
Q

what organ plays a role in myasthenia gravis

A

thymus - 75% patients have hyperplasia or thymoma

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12
Q

clinical features of myasthenia gravis

A

fluctuating weakness - worse through the day

proximal limb weakness

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13
Q

most common presentation of mysasthenia gravis

A

extraocular, facial and bulbar weakness

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14
Q

treatment for myasthenia gravis

A

acetylcholinesterase inhibitor - pyridstigmine
thymectomy
immunomodulating
steroids/azathioprine

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15
Q

common causes of morbidity in myasthenia gravis

A

respiratory failure

aspiration pneumonia side effects from immunosuppression

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16
Q

what are clinical features of skeletal muscle disorders

A

proximal weakness - shoulder and hips
cant lift things/get out of chair
waddling gait - gower’s sign
LMN signs - weakness, wasting, hypoflexia, fasiculations

17
Q

what trigger fasiculations

A

stress
caffeine
fatigue

18
Q

what is myotonia

A

failure of muscle relaxation after use

19
Q

causes of muscle problems

A

inflammatory - dermatomyositis
polymyositis
inherited - muscular dystrophies
congenital

20
Q

polymyositis presentation

A

symmetrical progressive proximal weakness

21
Q

what is raised in polymyositis

22
Q

what additional clinical feature is present in dermatomyositis

A

skin lesions

heliotrope rash on face

23
Q

treatment for polymyositis/dermatomyositis

24
Q

what is the most common muscular dystrophy

A

myotonic dystrophy

25
mode of inheritance of myotonic dystrophy
autosomal dominant - trinucleotide repeat disorder with anticipation
26
clinical features of myotonic dystrophy
``` myotonia weakness cataracts ptosis frontal balding cardiac defects ```
27
what conditions are mitochondrial disease associated with
deafness diabetes epilepsy
28
what drugs can cause muscular dystrophies
statins anaesthetic agents cocaine GHB venoms
29
how does rhabdomyolysis cause muscular dystrophy
dissolution of muscle | leakage of toxic intracellular contents into plasma
30
clinical features of rhabdomyolysis
triad of: myalgia weakness myoglobinuria (dark urine)