Question 1

A patient has a severe case of generalized myasthenia gravis. It is most important that the patient be monitored for:

Accepted Answer

A)  urine output. 
B)  atrial fibrillation. 
C)  hypotension. 
D)  apnea. 
A)  urine output. 
B)  atrial fibrillation. 
C)  hypotension. 
D)  apnea. D

Question 2

Which of the following values would be associated with impending ventilatory failure in a patient with myasthenia gravis?
1) NIF -15 cm H2O
2) VC 10 mL/kg
3) PaCO2 44 mm Hg
4) pH 7.36

Accepted Answer

A) 1, 4 
B) 1, 2 
C) 2, 4 
D) 1, 2, 3 
A) 1, 4 
B) 1, 2 
C) 2, 4 
D) 1, 2, 3 B

Question 3

Which of the following are among the therapy modalities for the patient with myasthenia gravis?
1) Acetylcholinesterase inhibitors
2) Chronic immunotherapies
3) Rapid immunotherapies
4) Monoamine oxidase inhibitors

Accepted Answer

A) 1, 3 
B) 2, 4 
C) 1, 2, 3 
D) 2, 3, 4 
A) 1, 3 
B) 2, 4 
C) 1, 2, 3 
D) 2, 3, 4 C

Question 4

Which of the following are associated with myasthenia gravis?
1) It interferes with acetylcholine transmission.
2) It causes weakness of voluntary muscles.
3) It is usually an ascending paralysis starting in the legs.
4) It is usually preceded by a viral infection.

Accepted Answer

A) 1, 2 
B) 3, 4 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 2 
B) 3, 4 
C) 2, 3, 4 
D) 1, 2, 3

Question 5

The major pathologic or structural changes of the lungs associated with myasthenic crisis include:
1) alveolar consolidation.
2) airway obstruction.
3) mucus accumulation.
4) hyperinflation.

Accepted Answer

A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 4 
B) 2, 3 
C) 2, 3, 4 
D) 1, 2, 3

Question 6

If a patient with myasthenia gravis is given edrophonium, what response would be expected?

Accepted Answer

A)  Diaphragmatic strength will increase for 12 to 24 hours. 
B)  Strength will temporarily improve for 10 minutes. 
C)  Muscle strength will increase for 48 to 72 hours. 
D)  Muscle strength will decrease for 10 minutes. 
A)  Diaphragmatic strength will increase for 12 to 24 hours. 
B)  Strength will temporarily improve for 10 minutes. 
C)  Muscle strength will increase for 48 to 72 hours. 
D)  Muscle strength will decrease for 10 minutes.

Question 7

In which clinical classification of myasthenia gravis is intubation indicated?

Accepted Answer

A)  Class I 
B)  Class 1IIb 
C)  Class V 
D)  Class II 
A)  Class I 
B)  Class 1IIb 
C)  Class V 
D)  Class II

Question 8

What is the most sensitive diagnostic test for myasthenia gravis?

Accepted Answer

A)  Ice pack test 
B)  SFEMG 
C)  Edrophonium test 
D)  PEFR 
A)  Ice pack test 
B)  SFEMG 
C)  Edrophonium test 
D)  PEFR

Question 9

A physician recommended a thymectomy for a patient with generalized myasthenia gravis. The primary benefit of this procedure is to:

Accepted Answer

A)  eliminate the source of AChR antibodies. 
B)  block the antigen-antibody reactions. 
C)  remove the source of cholinesterase. 
D)  cure the ocular myasthenia gravis. 
A)  eliminate the source of AChR antibodies. 
B)  block the antigen-antibody reactions. 
C)  remove the source of cholinesterase. 
D)  cure the ocular myasthenia gravis.

Question 10

What percentage of patients with only ocular myasthenia gravis are seropositive?

Accepted Answer

A)  <10% 
B)  25% 
C)  50% 
D)  90% 
A)  <10% 
B)  25% 
C)  50% 
D)  90%

Question 11

Which of the following disrupts the nerve impulse transmission in myasthenia gravis?

Accepted Answer

A)  MuSK 
B)  Edrophonium 
C)  IgG antibodies 
D)  RNS 
A)  MuSK 
B)  Edrophonium 
C)  IgG antibodies 
D)  RNS

Question 12

A 50-kg (110-pound) 30-year-old female patient has myasthenia gravis. Bedside spirometry has found her VC to be 700 mL and NIF -14 cm H2O. Vital signs show a respiratory rate of 38 breaths/min, a heart rate of 140/minute, and blood pressure of 130/90 mm Hg. What should the respiratory therapist recommend?

Accepted Answer

A)  Check the vital signs every hour. 
B)  Encourage airway clearance per protocol. 
C)  Administer supplemental oxygen per protocol. 
D)  Initiate mechanical ventilation per protocol. 
A)  Check the vital signs every hour. 
B)  Encourage airway clearance per protocol. 
C)  Administer supplemental oxygen per protocol. 
D)  Initiate mechanical ventilation per protocol.

Question 13

Which of the following are signs and symptoms associated with myasthenia gravis?
1) Double vision
2) Weakness of neck muscles
3) Drooping of eyelids
4) Temporary muscle fatigue

Accepted Answer

A) 1, 2 
B) 1, 4 
C) 2, 3, 4 
D) 1, 2, 3 
A) 1, 2 
B) 1, 4 
C) 2, 3, 4 
D) 1, 2, 3

Question 14

Complications commonly associated with long-term use of steroids in the management of myasthenia gravis include:
1) infections.
2) cataracts.
3) pulmonary edema.
4) osteoporosis.

Accepted Answer

A) 1, 3 
B) 1, 2 
C) 2, 3, 4 
D) 1, 2, 4 
A) 1, 3 
B) 1, 2 
C) 2, 3, 4 
D) 1, 2, 4

Question 15

During a myasthenia crisis, a patient was placed on mechanical ventilation but is now stable. What will the chest radiograph most likely show?

Accepted Answer

A)  Normal lungs 
B)  Mediastinal shift 
C)  Pericardial tamponade 
D)  Ground-glass appearance 
A)  Normal lungs 
B)  Mediastinal shift 
C)  Pericardial tamponade 
D)  Ground-glass appearance

Question 16

Which demographic groups are most likely to develop myasthenia gravis?
1) Females >40 years of age
2) Males <35 years of age
3) Females 15 to 35 years of age
4) Males 40 to 70 years of age

Accepted Answer

A) 1, 2 
B) 3, 4 
C) 2, 3 
D) 1, 4 
A) 1, 2 
B) 3, 4 
C) 2, 3 
D) 1, 4

Question 17

Which of the following is considered a disadvantage of the edrophonium test?

Accepted Answer

A)  It is associated with false-negative and false-positive results about 50% of the time. 
B)  It should not be given to you patients with a history of asthma. 
C)  It can be complicated by cholinergic side effects. 
D)  Initiate mechanical ventilation per protocol is likely following the test. 
A)  It is associated with false-negative and false-positive results about 50% of the time. 
B)  It should not be given to you patients with a history of asthma. 
C)  It can be complicated by cholinergic side effects. 
D)  Initiate mechanical ventilation per protocol is likely following the test.

Question 18

What test is usually performed to confirm the diagnosis of myasthenia gravis?

Accepted Answer

A)  RNS 
B)  PFT 
C)  CBC 
D)  EEG 
A)  RNS 
B)  PFT 
C)  CBC 
D)  EEG

Question 19

A patient with myasthenia gravis will have lung volume and capacity findings that indicate a(n):

Accepted Answer

A)  upper airway obstruction. 
B)  obstructive pulmonary disorder. 
C)  restrictive pulmonary disorder. 
D)  combined obstructive and restrictive disorder. 
A)  upper airway obstruction. 
B)  obstructive pulmonary disorder. 
C)  restrictive pulmonary disorder. 
D)  combined obstructive and restrictive disorder.

Question 20

What clinical change would be expected following a rest period for a patient with myasthenia gravis?

Accepted Answer

A)  There is no clinical change. 
B)  Strength decreases. 
C)  Muscle strength improves. 
D)  Ascending paralysis descends. 
A)  There is no clinical change. 
B)  Strength decreases. 
C)  Muscle strength improves. 
D)  Ascending paralysis descends.

Exam 30: Myasthenia Gravis

A patient has a severe case of generalized myasthenia gravis. It is most important that the patient be monitored for:

Which of the following values would be associated with impending ventilatory failure in a patient with myasthenia gravis? 1) NIF -15 cm H2O 2) VC 10 mL/kg 3) PaCO2 44 mm Hg 4) pH 7.36

Which of the following are among the therapy modalities for the patient with myasthenia gravis? 1) Acetylcholinesterase inhibitors 2) Chronic immunotherapies 3) Rapid immunotherapies 4) Monoamine oxidase inhibitors

Which of the following are associated with myasthenia gravis? 1) It interferes with acetylcholine transmission. 2) It causes weakness of voluntary muscles. 3) It is usually an ascending paralysis starting in the legs. 4) It is usually preceded by a viral infection.

The major pathologic or structural changes of the lungs associated with myasthenic crisis include: 1) alveolar consolidation. 2) airway obstruction. 3) mucus accumulation. 4) hyperinflation.

If a patient with myasthenia gravis is given edrophonium, what response would be expected?

In which clinical classification of myasthenia gravis is intubation indicated?

What is the most sensitive diagnostic test for myasthenia gravis?

A physician recommended a thymectomy for a patient with generalized myasthenia gravis. The primary benefit of this procedure is to:

What percentage of patients with only ocular myasthenia gravis are seropositive?

Which of the following disrupts the nerve impulse transmission in myasthenia gravis?

Which of the following are signs and symptoms associated with myasthenia gravis? 1) Double vision 2) Weakness of neck muscles 3) Drooping of eyelids 4) Temporary muscle fatigue

Complications commonly associated with long-term use of steroids in the management of myasthenia gravis include: 1) infections. 2) cataracts. 3) pulmonary edema. 4) osteoporosis.

During a myasthenia crisis, a patient was placed on mechanical ventilation but is now stable. What will the chest radiograph most likely show?

Which demographic groups are most likely to develop myasthenia gravis? 1) Females >40 years of age 2) Males <35 years of age 3) Females 15 to 35 years of age 4) Males 40 to 70 years of age

Which of the following is considered a disadvantage of the edrophonium test?

What test is usually performed to confirm the diagnosis of myasthenia gravis?

A patient with myasthenia gravis will have lung volume and capacity findings that indicate a(n):

What clinical change would be expected following a rest period for a patient with myasthenia gravis?

The Patient Interview

The Physical Examination

The Pathophysiologic Basis for Common Clinical Manifestations

Pulmonary Function Testing

Blood Gas Assessment

Assessment of Oxygenation

Assessment of the Cardiovascular System

Radiologic Examination of the Chest

Other Important Tests and Procedures

The Therapist-Driven Protocol Program

Respiratory Insufficiency, Respiratory Failure and Ventilatory Management Protocols

Recording Skills and Intra-Professional Communication

Chronic Obstructive Pulmonary Disease, Chronic Bronchitis and Emphysema

Asthma

Cystic Fibrosis

Bronchiectasis

Atelectasis

Pneumonia, Lung Abscess Formation, and Important Fungal Diseases

Tuberculosis

Pulmonary Edema

Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension

Flail Chest

Pneumothorax

Pleural Effusion and Empyema

Kyphoscoliosis

Cancer of the Lung, Prevention and Palliation

Interstitial Lung Diseases

Acute Respiratory Distress Syndrome

Guillain-Barré Syndrome

Cardiopulmonary Assessment and Care of Patients With Neuromuscular Disease

Sleep Apnea

Newborn Assessment and Management

Pediatric Assessment, Protocols, and Pals Management

Meconium Aspiration Syndrome

Transient Tachypnea of the Newborn

Respiratory Distress Syndrome

Pulmonary Air Leak Syndrome

Respiratory Syncytial Virus Infection Bronchiolitis

Chronic Lung Disease of Infancy

Congenital Diaphragmatic Hernia

Congenital Heart Disease

Croup and Croup-Like Syndromes: Laryngotracheobronchitis, Bacterial Tracheitis, and Acute Epiglottitis

Near Drowningwet Drowning

Smoke Inhalation, Thermal Injuries, and Carbon Monoxide Intoxication

Filters

Which of the following values would be associated with impending ventilatory failure in a patient with myasthenia gravis? 1) NIF -15 cm H₂O 2) VC 10 mL/kg 3) PaCO₂ 44 mm Hg 4) pH 7.36