MG Guidelines

Question 1

What percent of thymoma patient have MG?

Answer 1

30

Question 2

What percent of MG patients have thymic hyperplasia?

Answer 2

60

Question 3

What virus infection is correlated with MG?

Answer 3

EBV

Question 4

What sign? Ptosis is accentuated by passively opening the contralateral eye

Answer 4

Herring sign

Question 5

What is the Coogan sign?

Answer 5

Repetitive manual elevation of the ptotic eye causes drooping of the opposite lid

Question 6

What is the quickest way to improve MG strength?
Edrophonium
Mestinon
Neostigmine

Answer 6

Edrophonium immediately
Mestinon 60 to 90 mins
Neostigmine 15 mins

Question 7

What muscle is used for jitter?

Answer 7

Extensor digitorum communis

Question 8

What type of achr antibody is most common for MG patients?

Answer 8

BINDING 88%

Question 9

Which achr ab has the best prognosis? Ocular MG

Answer 9

Blocking

Question 10

What percentage of patients are negative for AchR antibody?

Answer 10

10-15%

Question 11

What type of MG is unresponsive to Mesinon?

Answer 11

Anti musk

Question 12

What abtibody is associated with the ff hla

dr14 and dq5

Answer 12

anti musk

Question 13

What hla is associated with achr antibodies?

Answer 13

a1 b8 dr3

Question 14

What is the daily limit of mestinon

Answer 14

900

Question 15

Re mestinon
Half life
Hours effects last
Bioavailability

Answer 15

Half life 20-30 mins
Hours effects last 4-6 hours
Bioavailability 10%

Question 16

Which immunologic agent?
Antifolate inhibiting purine and pyrimidine synthesis
Monoclonal antibody against cd20
Inhibits tcell activation and proliferation

Answer 16

Antifolate inhibiting purine and pyrimidine synthesis METHOTREXATE
Monoclonal antibody against cd20 RITUXIMAB
Inhibits tcell activation and proliferation TACROLIMUS

Question 17

What are the requirements to thymectomy in NON thymomatous MG

Answer 17

Stage 2a or better
18-55 years old
Rapid disease progression
Duration is within 3-5 years prior to sx
High level of antibodies to Ach ab

Question 18

When does improvement with steroids start? Maximal benefit achieved? Dose to start in hospital setting? Dose to start in OPD?

Answer 18

2-4 weeks
6 months
1mg per kg
10-20mg per day until 100mg per day

Question 19

What set of patients cannot take AZA for Mg

Answer 19

thiopurine methyltransferase deficiency

Question 20

What is the MOA of azathioprine?

Answer 20

purine antimetabolite interfering with b and t cell production

Question 21

What is the starting dose and goal dose of aza?

Answer 21

50mg od

goal 2-3mg per kg per day

Question 22

Cyclosporine MOA?

Answer 22

blocks calcineurin mediated cytokine signalling thereby inhibiting T cell helper function

Question 23

What are the adverse effects of cyclosporine? Daily dose?

Answer 23

Htn and renal damage

4-6mg per kg

Question 24

What immunologic agent blocks the enzyme inosine monophosohate dehydrogenase?

Answer 24

Mycophenolate mofetil

Question 25

What values indicate crisis? Vital capacity Negative inspiratory force Positive expiratory force

Answer 25

less than 1L less than 20 h20 less than 40cm h2o

Question 26

What is the rate of arrythmias in cardiac patients?

Answer 26

11-14%

Question 27

How long does Plex IVIG Have effect in crisis

Answer 27

Plasma 1-2 days | IVIG 4-5 days

Question 28

MGFA class? Moderate weakness of extremities mainly oropharyngeal respiratory Intubation

Answer 28

Moderate weakness of extremities mainly oropharyngeal respiratory 3b Intubation 5 OCULAR IS 1

Question 29

What medication is CONTRAINDICATED IN MG?

Answer 29

D Penicillamine

Question 30

What drugs MIGHT exacerbate MG?

Answer 30

``` CLIBS Calcium channel blocker Lithium Iodinated contrast Beta blocker Statins ```

Question 31

What percent of MG patients have thymoma?

Answer 31

15