Myasthenia Gravis (MG) - Winning Wednesday NCLEX Review

Introduction

Regina’s daughter had strep throat symptoms (sore throat, white patches, nausea, vomiting).
Shared personal experience to engage the audience.

Mention of the Quick Facts book for NCLEX review (offered at a discount).
Emphasizes the importance of starting with basics before jumping into question banks.

Type: Autoimmune disease.
Key Feature: Muscle weakness that worsens after periods of activity and improves after rest.
Name Breakdown: “Myasthenia” (muscle) “Gravis” (grave/severe condition).

Skeletal Muscles: Muscles under voluntary control, including diaphragm.
Possible Emergencies: Respiratory emergency due to diaphragm involvement.
Other Symptoms: Ocular symptoms, difficulty swallowing, impaired speech, weakness in limbs and neck.

Cause: Error in nerve signal transmission to muscles due to interrupted communication at the neuromuscular junction.

Ocular: Drooping eyelids (ptosis), double/blurry vision (ocular MG).
Physical: Changes in facial expression, difficulty swallowing, shortness of breath, impaired speech, generalized limb weakness.
Severity: Ranges from mild fatigue to respiratory failure.

Physical & Neurological Exam: Muscle strength, tone, coordination, sense of touch, eye movement.
Endrophonium Test: Injection affects acetylcholine breakdown, results in temporary muscle strength improvement.
Blood Tests: Elevated acetylcholine receptor antibodies indicate autoimmune response.
Electrodiagnosis: Repeated nerve stimulation shows muscle fatigue over time.
Imaging: CT or MRI to check for thymoma (thymus gland growth).
Pulmonary Function Testing: Measures breathing strength and respiratory capacity.

Medications:
- Cholinesterase Inhibitors: Neostigmine to slow down acetylcholine breakdown.
- Immunosuppressants: Prednisone to suppress abnormal antibody production (side note: not for inflammation reduction but immune suppression).
Surgical: Thymectomy to remove thymus gland reducing antibody production.
Procedures/Therapies:
- Plasmapheresis: Removing and replacing harmful antibodies in plasma.
- IV Immunoglobulin: Injection that binds and removes antibodies from circulation.

Vital Monitoring: Respiratory status, ability to cough and deep breathe.
Emergency Preparedness: Have suctioning and emergency equipment ready due to risk of myasthenic crisis.
Safety Measures: Monitor speech and swallowing to prevent aspiration, encourage sitting while eating.
Medication Administration: As prescribed.
Patient Education: Medic Alert bracelet.

Examples: Provided practice questions with explanations to test understanding.

Encouragement and Resources: Emphasizes taking small steps, offers contact for further questions, and promotes V2 for NCLEX review.

Study Strategy: Emphasizes understanding fundamentals before diving into practice questions.
Utilizing Resources: Encourages use of Quick Facts, V2, and practice exams.