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Cadiopulmonary Medicine > Test 4 Ch. 30 Myasthenia Gravis > Flashcards

Test 4 Ch. 30 Myasthenia Gravis Flashcards

1
Q

The most common chronic disorder of neuromuscular junction and interferes (blocks) w/ the chemical of acetylcholine (ACh)

A

Myasthenia gravis

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2
Q

What is the hallmark clinical features of MG is

A

fluctuating skeletal muscle weakness, often with true muscle fatigue

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3
Q

What are the 2 clinical types of myasthenia gravis:

A
  1. ocular
  2. generalized
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4
Q

The muscle weakness is limited to the eyelids and extra ocular muscles

A

ocular

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5
Q

In generalized myasthenia gravis the muscle weakness involves a variable combination of

A
  1. Muscle of the mouth and throat responsible for speech and swallowing (bulbar muscles)
  2. limbs
  3. respiratory muscles
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6
Q

When the diaphragm is involved vent failure can develop producing

A

myasthenia crisis

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7
Q

Pathologic or structural changes in MG

A
  • Mucus accumulation
  • Airway obstruction
  • Alveolar consolidation
  • Atelectasis
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8
Q

MG appears to be related to

A

ACh receptors antibodies (IgG) that block the nerve impulse transmissions at the neuromuscular junction

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9
Q

Pts who have detectable antibodies to the AChR

A

seropositive MG

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10
Q

Lacking both AChR or MuSK antibodies

A

seronegative MG

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11
Q

Typically is the ocular MG (50%)

A

seropositive

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12
Q

90% of cases of generalized MG are

A

seronegative

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13
Q

Screening methods and test used to diagnose MG includes

A
  1. clinical presentation and history
  2. bedside test
  3. immunologic studies
  4. electrodiagnostic studies
  5. evaluation of conditions associated w. MG
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14
Q

The hallmark of MG is

A

chronic muscle fatigue

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15
Q

Signs and symptoms include

A
  • facial muscle weakness
  • ptosis
  • diplopia
  • ophthalmoplegia
  • difficultly in breathing
  • speaking
  • chewing
  • swallowing
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16
Q

drooping of one or both eyelids

A

ptosis

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17
Q

double vision

A

diplopia

18
Q

paralysis or weakness of one of more of the muscles that control eye movement

A

ophthalmoplegia

19
Q

Ice pack tea is a very _______, _____, and __________ procedure for diagnosing MG in pts who have _______

A

simple, safe; reliable
ptosis

20
Q

The test consist of the application of an ice pack for __ to __ minutes

A

3 to 5

21
Q

The test Is considered positive if

A

there is improvement of the ptosis ( an increase of at least 2 mm in the palpebral fissure from before the test

22
Q

What test is used for pts w/ obvious ptosis or ophthalmoparesis

A

edrophonium (Tensilon) test

23
Q

Edrophonium is a short acting drug that blocks

A

cholinesterase from breaking down ACh after it has been released from the terminal axon

24
Q

If it gets better after getting Edophnium (Tensilon) then the pt is

A

postive

25
Q

Removal of the thymus gland

A

thymectomy

26
Q

A benign tumor of the thymus gland that may associated w/ MG

A

thymoma

27
Q

Clinical manifestations of MG

A
  • atelectasis
  • alveolar consolidation
  • excessive bronchial secretions
28
Q

Respiratory Rate

A
  • Varies w/ the degree of respiratory muscle paralysis
  • Apnea (in severe cases)
29
Q

Chest Assessment Findings

A
  • Diminished breath sounds
  • crackles
30
Q

Radiologic Findings

A
  • Normal
  • Increased opacity (when atelectasis or consolidation is present)
31
Q

Clinical indicators or impending acute vent failure include:

A
  • FVC <20 mL/kg
  • MIP below -30 cm H20
  • MEP <40 mmHg
  • pH <7.35
32
Q

The 4 basic therapeutic modalities used to treat MG are:

A
  1. symptomatic treatment (acetylcholinesterase inhibitors)
  2. chronic immunotherapies
  3. rapid immunotherapies
  4. thymectomy
33
Q

These are recommended as the first line of tx for symptomatic MG

A

acetylcholinesterase inhibitors

34
Q

This is the first choice

A

Pyridostigmine (Mestinon)

35
Q

Chronic immunotherapies (long term) agents include

A
  • glucocorticoids
  • Azathioprine
  • mycophenolate mofetil
  • cyclosporine
36
Q

Rapid immunotherapies

A
  • Plasmapheresis (plasma exchange )
  • Intravenous immune globulin (IVIG)
37
Q

Questions from the back
The onset of the signs and symptoms of MG is:
1. Slow and insidious
2. Sudden and rapid
3. Intermittent
4. Often elusive

A
  1. Slow and insidious
  2. Sudden and rapid
  3. Intermittent
  4. Often elusive
38
Q

Myasthenia gravis:
1. Is more common in young men
2. Has a peak age of 15 to 35 years
3. Is often provoked by emotional upset physical stress
4. Is associated w/ receptor- binding antibodies

A
  1. Has a peak age of 15 to 35 years
  2. Is often provoked by emotional upset physical stress
  3. Is associated w/ receptor- binding antibodies
39
Q

Which of the following is associated w/ MG
1.Bronchospasm
2. Mucus accumulation
3. Alveolar hyperinflation
4. Atelectasis

A
  1. Mucus accumulation
  2. Atelectasis
40
Q

When monitoring pts w/ MG all of the following are indicators if acute vent failure except:
a. pH:7.31
b. PaCO2: 55 mm Hg
c. FVC: 25 mL/kg
d. MIP:-15 cm H20

A

c. FVC: 25 mL/kg

41
Q

Which of the following antibodies is believed to block the nerve impulses transmission at the neuromuscular junction in MG
a. IgG
b. IgE
c. IgA
d. IgM

A

a. IgG

Cadiopulmonary Medicine (24 decks)

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