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Neuro-Malloy > Thyroid Eye Disase > Flashcards

Thyroid Eye Disase Flashcards

1
Q

If patient presents with bilateral proptotic eyes, what type of scan should we get?

A

CT scan

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2
Q

If a patient presents with a unilateral proptotic eye, what type of scan should we get?

A

MRI

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3
Q

In TED, whereever the eye cannot go, the ______ muscle is enlarged.

A

opposite

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4
Q

Absence o exophthalmos may mean what?

A

posterior decompression of ON

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5
Q

What’s the most reliable sign of TED?

A

Upper lid retraction

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6
Q

A patient that complains of their jelly roll edema in TED will say its worse when?

A

Worse when waking up and if they sleep on their back

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7
Q

When performing the curtain test, the left eye looks ptotic. You pin it up, what happens to the right eye if OS is truly ptotic?

A

OD will droop

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8
Q

What are the 3 muscles affected in TED consecutively?

A
  1. IR
  2. MR
  3. SR
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9
Q

If IR is affected, which way will the patient have problems looking?

A
  • issues looking up

- always opposite of swollen muscle

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10
Q

What will be the first ocular symptom of TED?

A

Dry eye

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11
Q

If patient has a hard time looking out, if you take IOP what will happen?

A

IOP will increase

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12
Q

What are the labs that should be ordered for a possible TED patient that has never been dx?

A
  1. Serum TSH
  2. T3 + T4
  3. Anti-thyroid antibodies
  4. Thyroid Stimulating Immunoglobulin (TSI)
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13
Q

Which lab workup is important to determine if TED is present

A
  • Anti-thyroglobulin Ab

- Thyroperosidase Ab

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14
Q

What can the patient to do decrease the symptoms of TED and have a better prognosis?

A

stop smoking!

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15
Q

What is the tx if there’s significant EOM enlargement?

A
  1. Oral steroids for acute tx

2. Orbital decompression if compressive optic neuropathy is present

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16
Q

When is the only time EOM muscle is allowed?

A

TED must be stable and not worsening (usually ~ 2 years)

17
Q

What % of MG patients will present with a thymoma?

A

10%

18
Q

Does MG affect the pupils?

A

No!

19
Q

If the patient has purely ocular MG, what will be the symptoms?

A

diplopia and ptosis

20
Q

If the patient has genralized MG, what will be their symptoms?

A

Ocular symptoms and upper/lower limb weakness

21
Q

MG is characterized by a decrease in the number of ____ receptors?

A

ACH receptors due to antibodies binding to them

22
Q

MG is found in what type of ppl?

A
  1. Young women = 15-20

2. Old men = 50-60

23
Q

60% of MG patients will have an initial presenting ocular sign. Why?

A

the low diplopic threshold

- a small misalignment of the eyes can cause DV

24
Q

When a MG patient looks down and then straight ahead, the upper lid overshoots and then comes back down. What’s this called?

A

Cogan’s lid twitch

25
Q

MG patients have issues with what type of muscles?

A

Flexor muscles

26
Q

What are the 3 ACH receptor antibodies found in a MG pt?

A
  1. Binding
  2. Blocking
  3. Modulating
27
Q

What is the best antibody lab workup to get if patient cannot afford to get all 3?

A

Binding !

28
Q

If antibody testing came back negative but you still think the patient has MG, what’s the next step?

A
  1. Electomyography (EMG)

- in purely ocular MG, antibodies are only present 50% of time

29
Q

An EMG tests for fatigability by repeatedly stimulating muscle nerve fibers from what 2 muscles?

A
  1. Frontalis

2. Orbicularis Oculi

30
Q

A myasthenic ptosis worsens when?

A

In bright sunlight

31
Q

When performing the ice pack test on a possible MG patient, how will the ptosis change?

A

Improves with cold

- cold blocks reuptake of Ach

32
Q

Single fiber EMG is what % sensitive for MG? how long does it take?

A

95% sensitivity

takes 2 hours

33
Q

What % of purely ocular MG convert to generalized MG? Most convert in what timeframe?

A

40-85% convert by 36 months

34
Q

What is the most common tx for MG?

A

Mestinon - inhibits breakdown of ACh by ACHase

35
Q

If your MG patient has kidney disease, how would you change the dosage of Mestinon?

A
  • decrase the dosage

- Mestinon is excreted by the kidney

36
Q

MG gets worse during what time of the day?

A

Toward the end of the day

- gets better with sleep

Neuro-Malloy (16 decks)

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