IM EOR - Neuro: MS, MG, Guillain-Barre, Complex Regional Pain Syndrome, Peripheral Neuropathy

A 35-year-old woman comes to the office because of numbness and tingling in her lower limbs for the past two days. She reports a recent influenza infection which subsided three days ago. Over the past day, the numbness has become accompanied by weakness and spread to the upper extremities. Her temperature is 36.8°C (98.4°F), pulse is 78/min, respirations are 12/min, and blood pressure is 110/68 mm Hg. Which of the following test results will confirm the presumptive diagnosis? A. Albuminocytologic dissociation in cerebrospinal fluid B. Decreased cerebrospinal fluid glucose C. Positive edrophonium challenge D. Positive culture for Campylobacter jejuni

A (Albuminocytologic dissociation in cerebrospinal fluid) (Guillain-Barré syndrome (GBS) is an autoimmune diseases characterized by rapidly progressive, symmetrical, ascending muscle weakness. Albuminocytologic dissociation in the cerebrospinal fluid is the hallmark finding in GBS)

A 51-year-old man with no significant past medical history comes to the office because of difficulty walking for the past three days. He initially felt weak in both feet, but now the weakness has spread across both lower legs bilaterally. He also reports numbness and tingling in these areas. He states that he had abdominal pain, bloody diarrhea, and fever after eating chicken ten days ago. Which of the following organisms was this patient likely infected with prior to his difficulty walking? A. Campylobacter jejuni B. Klebsiella pneumoniae C. Salmonella typhi D. Shigella

A (Campylobacter jejuni) (Guillain-Barré syndrome (GBS) is a neurologic disease in which the immune system attacks Schwann cells, causing peripheral demyelination. It is commonly preceded by infection, often by Campylobacter jejuni)

A 30-year-old woman comes to the office because of weakness and fatigue for the past 4 months. She also describes double vision and says symptoms worsen at night. Physical examination shows bilateral ptosis and symmetrical weakness of the upper and lower extremities and trouble sustaining contraction. Edrophonium challenge leads to a brief improvement of the symptoms. Which of the following is the most appropriate next step in management? A. Chest CT B. Lumbar puncture C. MRI of brain and spinal cord D. Muscle biopsy

A (Chest CT) (Thymomas affect about 10-20% of patients with myasthenia gravis. Patients diagnosed with myasthenia gravis should therefore have thymoma ruled out via CT of the neck (unless the patient has Grave disease).)

A 51-year-old man comes to the emergency department because of decreased strength in both legs for 5 days. He says 2 weeks ago he had a dry cough and fever that resolved after 6 days. Five days ago, he began experiencing frequent cramps in both legs. 2 days ago he had difficulty standing, and now he is unable to move either leg. He denies recent trauma, visual disturbance, or changes in bowel or bladder behavior. Physical examination shows speech is normal, cranial nerves II-XII are normal, pupils are equal and reactive to light, no facial droop, hypotonia in hips, knees, and ankles, lower limb strength is 0/5 bilaterally, positive Beevor's sign, negative Babinski's sign, upper limb reflexes are normal, knee and ankle jerk reflexes are absent, sensation is normal along all extremities, and spine is non-tender with no gibbus. Which of the following is the most likely diagnosis? A. Guillain-Barré Syndrome B. Parkinson's Disease C Multiple Sclerosis D. Myesthenia Gravis E. Huntington's Disease

A (Guillain-Barré Syndrome ) (Guillain-Barré syndrome is characterized by rapid-onset muscle weakness from autoimmune damage to the peripheral nervous system. Guillain-Barré syndrome is diagnosed through exclusion of other possible causes along with cerebrospinal fluid analysis, nerve conduction studies, and/or magnetic resonance imaging)

A 28-year-old female presents to her primary care doctor complaining of new onset blurry vision. She first noticed her vision getting blurry toward the end of the day several days ago. Since then, she reports that her vision has been fine when she wakes up but gets worse throughout the day. She has also noticed that her eyelids have started to droop before she goes to bed. On exam, she has bilateral ptosis that is worse on the right. Administering edrophonium to this patient leads to an immediate improvement in her symptoms. Which of the following is most likely true about this patient's condition? An increasing response will be seen on repeated nerve stimulation A. It is associated with a benign proliferation of epithelial cells of the thymus B. It is associated with a neoplasm of lung neuroendocrine cells C. It is caused by antibodies directed against presynaptic P/Q calcium channels D. It is caused by a type III hypersensitivity reaction

A (It is associated with a benign proliferation of epithelial cells of the thymus) (The most likely diagnosis for this patient is myasthenia gravis (MG). MG is associated with the development of a thymoma and thymectomy can therefore lead to an improvement in symptoms in some patients)

A 30-year-old woman from Minneapolis presents to your office complaining of paresthesias, weakness, lack of coordination, and difficulty with gait. Her symptoms are worse after a hot shower. Examination of the cerebral spinal fluid shows oligoclonal bands of immunoglobulin G (IgG). The most likely diagnosis is: A. Multiple sclerosis B. Huntington's disease C. Parkinson's disease D. Neurofibromatosis E. Amyotrophic lateral sclerosis (ALS)

A (Multiple sclerosis)

An 58-year-old woman comes to the emergency department because of double vision, and weakness in her arms and legs. She says the symptoms improve with rest and worsen throughout the day, especially after intensive exercise. Physical examination shows a right-sided eyelid droop and mild respiratory depression. Which of the following pharmacotherapies is most appropriate for this patient? A. Pyridostigmine B. Atropine C. Ipratropium D. Methacholine

A (Pyridostigmine) (Myasthenia gravis is a rare autoimmune neuromuscular disorder against nicotinic acetylcholine receptors. It is diagnosed and treated using acetylcholinesterase inhibitors.)

A 21-year-old woman is brought to your urgent care 30 minutes after an acute onset of double vision in the left eye. Two months ago, she had an acute episode of pain with movement of the left eye along with loss of both central vision and pupillary light reflex. These symptoms subsided spontaneously. Examination shows a delay in the adduction of the left eye with nystagmus of the right eye on lateral gaze. What is the most likely diagnosis? A. multiple sclerosis B. amyotrophic lateral sclerosis C. herpes zoster D. myasthenia gravis E. Guillain- Barré syndrome

A (multiple sclerosis)

A 27-year-old woman comes to your office for assessment of symptoms including weakness, visual loss, bladder incontinence, sharp shooting pain in the lower back, clumsiness when walking, and sensory loss. These symptoms have occurred during three episodes (different combinations of symptoms each time) approximately 3 months apart, and each episode lasted approximately 3 days. The first episode consisted of weakness, bladder incontinence, and sharp shooting pains in the lower back (in both hip girdles). The second episode consisted of visual loss, clumsiness when walking, and sensory loss. The third episode (last week) consisted of sharp shooting pains in the lower back and sensory loss (bilateral) in the upper extremities. There are four clinical categories of this disease. Which of the following subtypes does the patient presented fit into? A. relapsing-remitting B. secondary progressive C. primary progressive D. progressive relapsing

A (relapsing-remitting) (The most common pattern or clinical category of MS is the relapsing-remitting category. In relapsing-remitting MS, episodes of acute worsening are followed by recovery and a stable course between relapses. In the secondary progressive category, gradual neurologic deterioration occurs with or without superimposed acute relapses in patients who previously had relapsing-remitting MS. In primary progressive MS, gradual continuous deterioration occurs from the onset of symptoms. In progressive relapsing MS, gradual neurologic deterioration occurs from the onset of symptoms but with subsequent superimposed relapses. A small fraction of patients have a relatively benign form that never becomes debilitating. The patient described most likely has relapsing-remitting MS)

What is relapsing-remitting MS?

Attacks of unpredictable frequency, interspersed with periods of almost complete recovery. This is the most common presentation.

A 35-year-old man comes to the emergency department because of double vision and difficulty chewing for the past day. Symptoms improve with rest and worsen with extended periods of activity. Infusion with an agent produces improvement in his symptoms. Which of the following agents is most likely administered in such a scenario? A. Botulinum toxin B. Edrophonium C. Pilocarpine D. Scopolamine

B (Edrophonium) Myasthenia Gravis is characterized by muscle weakness that is worsened with continued activity. Alleviation of symptoms involves administration of an acetylcholinesterase inhibitor such as edrophonium (Tensilon).

A 43-year-old woman presents complaining of a "pins and needles" sensation that started bilaterally in her feet 2 days ago. The sensation now extends up to her mid-thighs. On physical examination, she is noted to have mild sensory loss, weakness, and absent reflexes bilaterally in her legs. Which of the following is the most likely diagnosis? A. diabetic peripheral neuropathy B. Guillain- Barré syndrome C. multiple sclerosis D. myasthenia gravis E. hypothyroidism

B (Guillain- Barré syndrome) (The pattern of sensory, motor, and reflex findings occurring over an acute time period is consistent with Guillain-Barré Syndrome. Diffuse diabetic peripheral neuropathy develops more insidiously than this case scenario. Multiple sclerosis presents with central nervous system (CNS) lesions that are unlikely to occur in this pattern. Myasthenia gravis causes intermittent motor symptoms without sensory involvement. Hypothyroidism may cause weakness and delayed reflexes, but is not the single best answer for this question)

A 43-year-old woman presents complaining of a "pins and needles" sensation that started bilaterally in her feet 2 days ago. The sensation now extends up to her mid-thighs. On physical examination, she is noted to have mild sensory loss, weakness, and absent reflexes bilaterally in her legs. Which of the following is the most likely diagnosis? A. diabetic peripheral neuropathy B. Guillain-Barré syndrome C. multiple sclerosis D. myasthenia gravis E. hypothyroidism

B (Guillain-Barré syndrome)

A 35-year-old paralegal arrives at the ED after hitting his head when he tripped while climbing the stairs to his office. He has noted his legs feeling heavy over the last 5 days and reported trouble pushing himself up after the fall. He experienced nausea, vomiting, and diarrhea 3 days ago (admits to eating discount sushi). Exam is remarkable for symmetric 3/5 lower and upper extremity weakness, absent ankle and patellar reflexes and 1+ biceps reflex. He is only able to count to 10 in one breath. Routine labs, chest x-ray, and head CT are unrevealing. What is the most likely diagnosis? A. Alzheimer disease B. Guillan-Barre syndrome C. Huntington disease D. Multiple sclerosis E. Parkinson disease

B (Guillan-Barre syndrome)

A 53-year-old man presents to the urgent care clinic. He reports difficulty with standing and walking due to muscle weakness that started a week ago. The weakness is now beginning to affect his arms. He cannot recall any inciting factors such as drug use or toxin exposure. He has otherwise been in good health, apart from a minor respiratory illness several weeks ago. Analysis of the cerebrospinal fluid shows elevated protein level with normal white blood cell count. Which of the following neurological disorders is most likely responsible for this patient's symptoms? A. Alzheimer disease B. Guillan-Barre syndrome C. Huntington disease D. Multiple sclerosis E. Parkinson disease

B (Guillan-Barre syndrome)

A 34-year-old woman comes to the clinic for the first time because of "tired eyes." She says that her eyelids "fall down" toward the end of the day which is problematic because she does a lot of computer work and her vision is being impeded. She often feels unable to reopen her eye until after she wakes up the next morning. She also has a 30-minute drive home from work which is now dangerous for her with this condition. Which of the following is the easiest test to perform to further elucidate the diagnosis? A. CT-head B. Ice pack test C. MRI-head D. Schirmer's test

B (Ice pack test) (Ocular myasthenia gravis occurs in 15% of patients with myasthenia gravis. This diagnosis can be quickly elucidated in the office with the ice-pack test. Ptosis will decrease after one minute of ice to the lids)

A 32-year-old man comes to your clinic because of "drooping eyelids" for the past month. He denies any trigger of the drooping and says the eyelids droop more in the morning, "like [his] eyes don't want to wake up when the rest of [him] does." Physical examination shows normal vision and no structural abnormalities on or around the eyes. Which of the following most appropriately describes this type of presentation? A. Amblyopia B. Bilateral Ptosis C. Ocular nerve palsy C. Congenital ptosis

C (Bilateral Ptosis) (Ptosis describes a drooping of the upper eyelid. This patient is suffering from this finding bilaterally. It has many causes including problems with the muscle that raises the lid, the oculomotor nerve that controls them, or the neuromuscular junction in between)

A 50-year-old man comes to the clinic because of muscle fatigue and difficulty raising his left eyelid. His medical history is noncontributory. Physical examination shows easy fatigability, with weakness that improves after rest but worsens with a repeat of the exertion test. The patient also shows a left-sided eye droop. A Tensilon test returns positive.. A serology test is performed to identify certain antibodies. Which of the following is most likely affected by the patient's condition? A. Acetylcholine B. Muscarinic acytelcholine receptor C. Nicotinic acytelcholine receptor D. Ocular nerve

C (Nicotinic acytelcholine receptor) (This patient has diplopia, ptosis, and muscle weakness that worsens with use.) Myasthenia gravis is an autoimmune neuromuscular disease characterized by the release of autoantibodies that attack nicotinic acetylcholine receptors in the neuromuscular junction.

A 71-year-old male arrives to the emergency room appearing cyanotic and having weak, shallow respirations. He is brought in by his home care nurse, who reports that the patient has a history of myasthenia gravis and frequent urinary tract infections. The patient was in his normal state of health until five days ago when he developed a urinary tract infection. He was prescribed gentamicin with improvement of his urinary symptoms. This morning, while trying to eat breakfast, he began complaining of poor grip strength and progressive difficulty breathing. The patient's medications include pyridostigmine and aspirin, both of which his nurse reports he takes every day as prescribed. The patient's temperature is 99°F (37.2°C), blood pressure is 128/78 mmHg, pulse is 92/min, and respirations are 28/min with an oxygen saturation of 86% O2 on room air. Upon physical exam, the patient is noted to have gray-blue skin, hypophonia, weak upper extremities, and normal leg strength. An arterial blood gas is drawn with results as shown below: PO2: 55 mmHg PCO2: 60 mmHg pH: 7.30 The patient is intubated. Which of the following is the next best step in management? A. Edrophonium B. Neostigmine C. Plasmapheresis D. Thymectomy

C (Plasmapheresis) This patient is presenting with a history of myasthenia gravis, recent exposure to an aminoglycoside, and respiratory failure, suggesting the diagnosis of myasthenic crisis. The best initial step in management is intubation and plasmapheresis.

_______________is the most common organism associated with Guillain-Barre syndrome.

Campylobacter jejuni

A 25-year-old female with a history of diarrhea presents to the emergency department with Guillain-Barre syndrome. What is the most likely causative pathogen in this patient? A. Shigella dysenteriae B. Yersinia enterocolitica C. Entamoeba histolytica D. Campylobacter jejuni

D (Campylobacter jejuni) (Campylobacter jejuni is a Gram-negative bacteria that has been linked to the subsequent development of Guillain-Barré syndrome (GBS). GBS usually develops two to three weeks after the initial illness)

A 60 year-old woman comes to the emergency department because of fever, chills, and a productive cough. The patient is hospitalized and treated with IV gentamicin but fails to improve. Physical examination shows bilateral ptosis that she admits worsens in the evening. She also complains of diplopia and blurry vision that was present for the past year but has become more pronounced since her admission. Which of the following is the most appropriate next step in management? A. Add ciprofloxacin and ceftriaxone B. Add ciprofloxacin C. CT scan of the chest D. Discontinue gentamicin E. Increase the dose of gentamicin

D (Discontinue gentamicin) (Myasthenia gravis is an autoimmune disease caused by antibodies against the nicotinic acetylcholine receptors at the postsynaptic neuromuscular junction. Medications such as aminoglycosides, tetracylines, beta-blockers and antiarrhythmics exacerbate symptoms of myasthenia gravis. Aminoglycosides are thought to affect the presynaptic release of acetylcholine.)

A 4-year-old previously healthy male presents with 4 days of intermittent vomiting and 5-6 daily loose stools. His mother noted bloody stools and decreased oral intake of food and water over the last 24 hours. He is normally in daycare; however, he has been home for the past 3 days. The next day, he complains of lower extremity weakness and tingling. On repeat exam, lower extremity strength is 3/5 with diminished patellar deep tendon reflexes. Which of the following lab findings would most likely be seen in this patient? A. Gram stain positive CSF B. Xanthochromia on cerebrospinal fluid analysis C. Oligoclonal bands on cerebrospinal fluid analysis D. Increased cerebrospinal fluid protein with normal cell count

D (Increased cerebrospinal fluid protein with normal cell count) (This child with diarrhea and fever followed by lower extremity weakness and hyporeflexia has Guillain-Barre syndrome (GBS) after gastrointestinal illness. Cerebrospinal fluid (CSF) will show increased cerebrospinal fluid protein with normal cell count (albuminocytologic dissociation).)

A 35-year-old woman presents with a 4-month history of dysarthria and muscle fatigue. She works as a nurse and at the end of her workday she notices profound difficulty enunciating her words and producing a full smile. These symptoms resolve after rest. On physical examination, you notice ptosis of the left eyelid on prolonged upgaze and progressive dysarthria while speaking. What is the most likely diagnosis? A. multiple sclerosis B. amyotrophic lateral sclerosis C. herpes zoster D. myasthenia gravis E. Guillain- Barré syndrome

D (Myasthenia gravis) (Myasthenia gravis is an immune-mediated disorder in which there are circulating antibodies against the postsynaptic nicotinic acetylcholine receptors at the neuromuscular junction of skeletal muscle cells)

A 26-year-old female reports progressive distal to proximal spread of extremity weakness over the last 36 hours without fever, headache or syncope. Examination reveals symmetrical, paresis of the hands and feet with loss of the brachioradialis and Achilles reflexes. Biceps and knee reflexes are present but diminished. Sensory exam is normal. What are the most likely findings on cerebral spinal fluid (CSF) analysis? A. Decreased glucose, increased WBC count and decreased protein B. Increased glucose, normal WBC count and normal protein C. Normal glucose, decreased WBC count and elevated protein D. Normal glucose, normal WBC count and elevated protein

D (Normal glucose, normal WBC count and elevated protein)

A 32-year-old man comes to the office because of symmetric weakness in his lower extremities for the past week. The weakness began in the distal lower extremities, but he has noticed that it has spread to above his knees over the past three days. He has also started to have trouble walking. He reports getting over an episode of food poisoning two weeks ago. Physical examination shows weakness in his lower limbs with diminished patellar and calcaneal reflexes. Which of the following structures is most likely damaged in this patient? A. Ependymal cells B. Lower motor neurons C. Muscle fibers D. Schwann cells

D (Schwann cells) (Guillain-Barré syndrome (GBS) is a peipheral neuron disease that often occurs after an infection and can be caused by an immune-mediated attack on Schwann cells.)

A 55-year-old woman comes to the emergency department with fever, chills, and a copious productive cough. The patient is hospitalized and treated with IV gentamicin but fails to improve. She also says she has diplopia and blurry vision that was present for the past year but has become more pronounced since her admission. Physical examination shows bilateral ptosis that the patient notes worsens throughout the day. Which of the following would most likely confirm the diagnosis of this patient's current condition? A. CT scan of thorax B. Edrophonium (Tensilon) test C. Muscle biopsy D. Single fiber electromyography (SFEMG)

D (Single fiber electromyography (SFEMG)) (Myasthenia gravis is often diagnosed using the Tensilon test. However, it is most definitively diagnosed with single fiber electromyography which shows a decremental response to motor nerve stimulation)

A 35-year-old woman presents with a history of a self-limited upper respiratory illness 3 weeks prior to this clinic visit. She now complains of persistent weakness and malaise, which worsens near the end of the day. She complains that she has a difficult time keeping her right eye open during the later part of the day. Taking a nap often helps. You notice that her right eyelid covers the top portion of her pupil. Pupillary reactions are normal. A complete neurological evaluation is otherwise negative. Which evaluation is most likely to confirm your preliminary diagnosis? A. CT scan of the brain B. lumbar puncture C. funduscopic examination D. Tensilon test E. psychiatric evaluation

D (Tensilon test) (Tensilon (edrophonium) testing will confirm that this patient has a classic presentation of myasthenia gravis.)

A 31-year-old woman comes to the office because of a left-sided facial droop that began 1 hour ago. She says for the past 3 days she has had difficulty swallowing. Medical history is noncontributory. Symptoms are relieved by rest. Infusion of an agent produces improvement in her symptoms. Physical examination shows mild respiratory depression and various cranial nerve dysfunctions. Which of the following additional findings is most likely to be seen in this patient? A. Medullary thyroid carcinoma B. Prolactinoma C. Small cell lung carcinoma D. Thymoma

D (Thymoma) (Myasthenia gravis is an autoimmune, neuromuscular disorder that is commonly associated with thymomas and thymic hyperplasia. A CT of the chest will confirm a thymoma which is then treated with surgery. Symptoms usually improve post thymectomy)

a 60-year-old female with complaints of muscle weakness, weakness of the eyelid muscles, double vision, fatigable chewing and breathing problems. When questioned further she complains of difficulty with everyday activities like brushing her hair. What is the most likely diagnosis? A. multiple sclerosis B. amyotrophic lateral sclerosis C. herpes zoster D. myasthenia gravis E. Guillain- Barré syndrome

D (myasthenia gravis)

________________ is an acetylcholinesterase inhibitor drug that is used to diagnose myasthenia gravis.

Edrophonium

The most common viral causes of Guillain-Barre syndrome are cytomegalovirus and __________ __________ virus.

Epstein-Barr

(Females/Males) are more affected by myasthenia gravis.

Females

__________________ is a life-threatening neuropathy involving ascending paralysis and eventual death from respiratory paralysis and cardiac arrest.

Guillain-Barre syndrome

What condtion: Presents with weakness of the legs, progressing to total paralysis of all four limbs, facial muscles, and eyes. Loss of reflexes.

Guillan-Barre syndrome

Guillain-Barre syndrome is a type (I/II/III/IV) hypersensitivity reaction.

II

Myasthenia gravis is a type ___ hypersensitivity disorder where autoantibodies target nicotinic acetylcholine receptors.

II

Multiple sclerosis is associated with a type ____ hypersensitivity reaction.

IV

_____________ is an interferon used to treat multiple sclerosis.

Interferon-beta

A 46-year-old man comes to the clinic because of muscle weakness for the past 2 days. He first noticed symptoms while he was spinning the wheel on The Price is Right. He says he also experienced double vision while driving to the clinic today. Physical examination shows right-sided ptosis. A test involving edrophonium is performed and the result is positive. Which of the following most accurately describes this patient's condition? A. It can be avoided by not giving honey to infants B. It is characterized by a production of antibodies against nicotinic acetylcholine receptors C. Muscle weakness improves with continued use D. The disorder often does not progress with age E. Treatment includes acetylcholinesterase agonist

It is characterized by a production of antibodies against nicotinic acetylcholine receptors Myasthenia gravis commonly presents with muscle weakness after repetitive use, diplopia, and ptosis. It is due to the development of autoantibodies against nicotine acetylcholine receptors on the postsynaptic membrane of the neuromuscular junction.

___________________ refers to an electrical shock sensation in the limbs and torso, brought on by movement (mostly flexion) of the neck, due to pathology of the cervical spinal cord.

Lhermitte's sign

The most sensitive and specific investigation for MS is __________ of the brain and spinal cord.

MRI

___________ is the gold standard for diagnosis of multiple sclerosis to view periventricular plaques.

MRI

____________ pupil, seen in multiple sclerosis, is due to a relative afferent pupillary defect resulting from optic nerve damage or severe retinal injury

Marcus Gunn

Lhermitte's sign is a common finding in early _____________.

Multiple sclerosis

Scanning speech, intention tremor, and nystagmus are a common symptom profile for ____________________.

Multiple sclerosis

What condition do you suspect: Sensory loss Optic neuritis Weakness Paresthesias

Multiple sclerosis

What condition do you suspect: A patient has recurrent visits for different neurologic symptoms, often the first visit is for visual problems, followed by weakness in distal limb, ataxia or paresthesias over several years.

Multiple sclerosis

What condition: Blurred vision with decreased acuity, double vision, paresthesias (numbness and tingling) in the extremities, ataxia, fatigue, and focal motor symptoms

Multiple sclerosis

__________________ is an autoinflammatory disease causing demyelination, neuronal loss, and scarring within the white matter of the brain and spinal cord.

Multiple sclerosis

_____________________ is a demyelinating disorder due to the autoimmune destruction of central nervous system myelin and oligodendrocytes.

Multiple sclerosis

What condition: Fluctuating weakness, often subtle, that worsens during the day and after prolonged use of affected muscles, may improve with rest Weakness in everyday activities like brushing hair (a common board presentation)

Myasthenia Gravis

What condition: Proximal to distal weakness Eyes: ptosis usually first Face: weak chewing Limbs: easy fatigue with movement/exercise

Myasthenia Gravis

_________________ involves an autoimmune attack of acetylcholine receptors at the neuromuscular junction results motor problems.

Myasthenia Gravis

____________________ causes intermittent motor symptoms without sensory involvement.

Myasthenia gravis

____________________ is the most common neuromuscular junction disorder.

Myasthenia gravis

_________________ and pyridostigmine are cholinesterase inhibitors that are used to treat myasthenia gravis.

Neostigmine

_________________ are cells of the central nervous system that are damaged in multiple sclerosis.

Oligodendrocytes

In Guillain-Barre because paralysis of chest muscles/diaphragm may lead to respiratory failure you must monitor _______________.

PFT's

Myasthenia Gravis is iagnosed with Acetylcholine receptor antibodies and Edrophonium (_______________), a short acting cholinesterase

Tensilon test

A _______________ in patients under 60 with Myathenia Gravis can be curative.

Thymectomy

Edrophonium is a(n) (drug class) ____________________ inhibitor drug used for the diagnosis of myasthenia gravis.

acetylcholinesterase

Guillain-Barre syndrome is a life-threatening neuropathy involving (ascending/descending) paralysis.

ascending

Myasthenia gravis is a neuromuscular junction disorder that is associated with malignancies like _____________ carcinoma or thymic neoplasm.

bronchogenic

Neostigmine and pyridostigmine are _____________________ that are used to treat myasthenia gravis.

cholinesterase inhibitors

Intravenous (drug class) _________________ are used to treat acute flares of multiple sclerosis.

corticosteroids

In Guillain-Barre syndrome, the presence of increased protein content with normal levels of white blood cells in the cerebrospinal fluid is called ______________ ________________.

cytoalbuminologic dissociation.

The most common viral causes of Guillain-Barre syndrome are ______________ and Epstein-Barr virus.

cytomegalovirus

The underlying mechanism of Guillain-Barre syndrome involves an autoimmune reaction where the immune system attacks the peripheral nerves resulting in ______________.

demyelination

Guillan-Barre syndrome is a ascending paralysis beginning in (distal / proximal) limbs.

distal

Multiple sclerosis begins with (proximal / distal) muscle weakness.

distal

DX of Guillain-Barre is based on lumbar puncture which reveals (decreased / elevated / normal) CSF protein with normal CSF WBC.

elevated

On boards Guillian-Barre will often present after __________________.

immunization

Acetylcholinesterase inhibitors (improve/worsen) the symptoms of myasthenia gravis.

improve

In Guillain-Barre syndrome, the analysis of the cerebrospinal fluid shows (normal/increased) protein content.

increased

The main lines of treatment of Guillain-Barre syndrome are __________________ and plasma exchange.

intravenous immunoglobulin

DX of Guillain-Barre is based on __________________ which reveals elevated CSF protein with normal CSF WBC.

lumbar puncture

Guillain-Barre syndrome is diagnosed based on ____________ = elevated CSF protein with normal CSF WBC

lumbar puncture

The hallmark of Myasthenia Gravis is ___________________

muscle fatigue

Multiple sclerosis is a demyelinating disorder due to the autoimmune destruction of central nervous system _________ and oligodendrocytes.

myelin

Myasthenia Gravis involves an autoimmune attack of acetylcholine receptors at the __________________ results motor problems.

neuromuscular junction

Myasthenia gravis is a type II hypersensitivity disorder where autoantibodies target __________________ _____________receptors.

nicotinic acetylcholine

DX of Guillain-Barre is based on lumbar puncture which reveals elevated CSF protein with (decreased / elevated / normal) CSF WBC.

normal

In Guillain-Barre syndrome, the analysis of the cerebrospinal fluid shows (normal/increased) white blood cell count.

normal

Myasthenia gravis symptoms generally starts with weakness of the ___________ muscles.

ocular

Guillain-Barre syndrome is caused by an autoimmune reaction that leads to demyelination in the (central/peripheral) nerves.

peripheral

The MRI scan will reveal ______________ and spotty and irregular demyelination in the affected areas in a patient with MS.

plaque formation

Guillain-Barre is treated with ______________ (remove circulating antibodies). Intravenous immunoglobulin (IVIG) other option but not as effective as plasma exchange

plasma exchange

The main lines of treatment of Guillain-Barre syndrome are intravenous immunoglobulin and _________________.

plasma exchange

IgG autoantibodies in multiple sclerosis target the _____________ channels on glial cells.

potassium

The weakness of Myasthenia Gravis starts (proximal / distal)

proximal

The classical clinical presentation of a patient with myasthenia gravis is a patient with (eye symptoms) ________ or _________ and muscle weakness that worsens with use.

ptosis, diplopia

Neostigmine and _____________ are cholinesterase inhibitors that are used to treat myasthenia gravis.

pyridostigmine

In Guillain-Barre because paralysis of chest muscles/diaphragm may lead to _______________ you must monitor PFT's.

respiratory failure

In Guillain-Barre syndrome, the muscle weakness is (symmetric/asymmetric) .

symmetric

Myasthenia gravis is a neuromuscular junction disorder that is associated with malignancies like bronchogenic carcinoma or ____________ neoplasm.

thymic

Neostigmine is used to (treat/diagnose) myasthenia gravis.

treat

Multiple sclerosis is usually present with _________________ often over many years.

visual disturbance

Myasthenia gravis causes intermittent motor symptoms (with / without) sensory involvement

without

Multiple Sclerosis is a demyelinating disorder that is more common in (men/women) in their 20s-30s living in temperate climates.

women