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Neurology > Myasthenia Gravis > Flashcards

Myasthenia Gravis Flashcards

1
Q

What is MG?

A

Myasthenia gravis

Autoimmune disease of NMJ

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2
Q

What antibodies are found in MG?

A

Acetylcholine receptor antiboides

Muscle-specific kinase (MuSK)

LRP4 (low-density lipoprotein receptor-related protein 4)

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3
Q

What is associated with MG?

A

Thymus abnormalities

  • thymoma
  • hyperplasia
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4
Q

What are the features of MG?

A

Fatigability of movements

Skeletal muslce
Extraocular muscles
Bulbar involvment

Ptosis
Diplopia
Swallowing problems
Dysarthria

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5
Q

What can trigger worsening of MG?

A

Stress
Pregnancy

Drugs

  • aminoglycosides
  • Beta blockers
  • CCBs
  • ACEis
  • Chloroquine
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6
Q

What can be seen on examination of a patient with MG?

A

Repeated blinking - worsens ptosis

Prolonged upwards gaze - worsen diplopa

Fatigability of limb movements

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7
Q

What investigations are done for suspected MG?

A

ACh-R antibodies
Tensilon test
CT thorax

Spirometry - check FVC

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8
Q

Why is a CT thorax done in MG?

A

Check for thymus abnormalities

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9
Q

What is a tensilon test?

A

IV edrophonium chloride (or neostigmine) given

Prevents the breakdown of ACh

Temporarily relieves weakness

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10
Q

Why is the tensilon test not often done anymore?

A

Risk of cardiac arrhythmias

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11
Q

How is MG managed?

A 
Supportive care
Ventilation if FVC <20
AChesterase inhibitors (pyridostigmine/neostigmine)
Corticosteroids
Azathioprine
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12
Q

What are complications of MG?

A 
Resp failure
Aspiration
VTE
Resp infections 
Myasthenic crisis
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13
Q

What is a myasthenic crisis?

A

Acute worsenign of symptoms triggered by other illnesses

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14
Q

How is a myasthenic crisis managed?

A

NIV

IV IG
Plasma exchange

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15
Q

What is a risk of pyridostigmine/neostigmine?

A

Cholinergic crisis

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16
Q

What are features of a cholinergic crisis?

A

Miosis

SLUDGE syndrome

17
Q

What is SLUDGE

A 
Salivation/sweating
Lacrimation
Urinary incontinence
Diarrhoea
GI distress
Emesis
18
Q

How is a cholinergic crisis managed?

A

Stop pyridostigmine

Anti-muscarinic

Neurology (23 decks)

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