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27 Cards in this Set
- Front
- Back
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Myesthenia gravis
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autoimmune disorder
-causes fluctuating weakness of voluntary muscles |
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SS of MG
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MC 1st SS: Ptosis, diplopia, blurred vision
2nd MC: weakness of facial & bulbar muscles -SS fluctuate daily |
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M to F ratio for MG
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F > in 30's
M > in 70's |
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grading score for motor strength
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5: normal strength
4: weak but able to resist examiner 3: moves against gravity but unable to resist examiner 2: moves but unable to resist gravity 1: flicker but no movement 0: no movement |
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Patho of MG
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neuromuscular disorder
-autoAbs agains ACh receptors -leads to destruction of the receptors (competition between antibodies and Ach to bind the receptors) -causes weakness and fatigue because only a certain amount of receptors are available -repeated stimulation to the same muscle causes fatigue |
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What are the hallmarks of Myasthenia gravis?
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muscular weakness and fatigability
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How can you differentiate MG to other problems?
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weakness is worse with exercise and better with rest
-proximal muscles are affected more than distal muscles |
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SS of MG
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upper eyelid droop, double vision,
muscle fatigue after exercise hard holding head erect (neck extensors effected more than flexors --> head droop) difficult chewing, swallowing, choking, drooling abn smile, intraocular weakness, ptosis respiratory weakness may result in acute respiratory failure |
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Diagnostic test for MG
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Acetylcholinesterase inhibitor administration
-Tensilon (ENdrophonium) test-IM prostigmin (neostigmine) test -blood test |
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Tensilon (endrophonium) test
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CI in asthma
-improve muscle weakness -fast onset of action (30 sec), short duration (5 min -if worsen --> cholinergic crisis |
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Prostigmin (Neostigmine) test
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IM
see effects in 30 mins. lasts 2 hours -pt may respond if they don't respond to Tensilon -good in kids & infants -CI: asthma & allergy |
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What should you always have in hand with the diag testing with Tensilon?
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Atropine for serious SE
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Bell's palsy
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idiopathic facial paralysis of lower motor neuron
-inflammation reaction |
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How can you tell the difference between a palsy and brain problem?
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if you can raise the eyebrow, then it is a brain problem
if there is no response --> nerve problem |
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Branchial motor part of CN 7
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special visceral efferent
-supplies muscles of facial expression & post belly of digastric muscle -stylohyoid & stapedius: pts complain of louder sounds & no TM damping |
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Visceral motor branch
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parasympathetic innervation
-lacrimal glands, submandibular/sublingual glands -mucous membranes of nasopharynx -hard & sof palate |
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Special sensory branch
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taste sensation in ant 2/3 of tongue
-hard & soft palates |
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General sensory
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small area behind ear (purely sensory)
-general sensation from skin of concha of auricle |
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What is the ages effected w/bell's palsy?
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15-45yrs
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SS of bell's palsy
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weakness/numbness
fullness/discomfort behind mastoid process -dry eyes, dec taste, intensified sounds ipsilateral eye closure impaired difficulty w/eating |
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If there is sparing of forehead muscles in unilateral facial paralysis, what is it?
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cortical lesion & not periphery --> STROKE
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What is an associated disease with Bell's?
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Ramsy Hunt Syndrome
-herpes zoster infection of geniculate ganglion (very close proximity of CN7) -facial weakness, ringing, vertigo -herpetic vesicles |
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if have bilateral facial paralysis, what do you think of?
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inflammation of infection
-lyme, Guillain Barre, sarcoidosis |
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no corneal reflex, what is it?
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CN5-brainstem ischemia
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tinnitus & deafness means?
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vestibulococh SS
-brainstem lesion, or acoustic neuroma |
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if have fever, ear drainage, parotid gland enlargement
-think of what/ |
infection
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Treatment for Bell palsy
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prednisone (helps w/duration & severity)
acyclovir & famiciclovir eye drops/eye patch PT surgical decompression |
