Question 1

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. A

Question 2

Which of the following are among the treatment options for the patient with myasthenia gravis?
1) Pyridostigmine (MestinonÒ)
2) Plasmapheresis
3) Thymectomy
4) Mechanical ventilation

Accepted Answer

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

Question 3

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. C

Question 4

A 50-kg (110-lb) 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 DB&C per protocol. 
C)  Administer supplemental oxygen per protocol. 
D)  Initiate mechanical ventilation per protocol. 
A)  Check the vital signs every hour. 
B)  Encourage DB&C per protocol. 
C)  Administer supplemental oxygen per protocol. 
D)  Initiate mechanical ventilation per protocol.

Question 5

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 6

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.

Question 7

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 8

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.

Question 9

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

Accepted Answer

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

Question 10

Which of the following disrupt(s) 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 11

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 12

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 13

Which demographic group(s) is/are most likely to develop myasthenia gravis?
1) African-American females >40 years of age
2) White males <40 years of age
3) Females 15 to 35 years of age
4) Males 40 to 70 years of age

Accepted Answer

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

Question 14

Which of the following is (are) signs and symptoms associated with myasthenia gravis?
1) Double vision
2) Weakness of neck muscles
3) Drooping of eyelids
4) Difficulty speaking

Accepted Answer

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

Complications commonly associated with long-term use of steroids in the management of myasthenia gravis include all of the following EXCEPT:

Accepted Answer

A)  infections. 
B)  cataracts. 
C)  pulmonary edema. 
D)  osteoporosis. 
A)  infections. 
B)  cataracts. 
C)  pulmonary edema. 
D)  osteoporosis.

Question 17

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 18

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 19

Which of the following values would be associated with impending ventilatory failure in a patient with myasthenia gravis?
1) NIF -15cm H2O
2) VC 10 mL/kg
3) PaCO243 mm Hg
4) pH 7.36

Accepted Answer

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

Exam 30: Myasthenia Gravis

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

Which of the following are among the treatment options for the patient with myasthenia gravis? 1) Pyridostigmine (MestinonÒ) 2) Plasmapheresis 3) Thymectomy 4) Mechanical ventilation

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

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

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

What is the most sensitive diagnostic test for myasthenia gravis?

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

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

Which of the following disrupt(s) the nerve impulse transmission in myasthenia gravis?

In which clinical classification of myasthenia gravis is intubation indicated?

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

Which demographic group(s) is/are most likely to develop myasthenia gravis? 1) African-American females >40 years of age 2) White males <40 years of age 3) Females 15 to 35 years of age 4) Males 40 to 70 years of age

Which of the following is (are) signs and symptoms associated with myasthenia gravis? 1) Double vision 2) Weakness of neck muscles 3) Drooping of eyelids 4) Difficulty speaking

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

Complications commonly associated with long-term use of steroids in the management of myasthenia gravis include all of the following EXCEPT:

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.

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

Which of the following values would be associated with impending ventilatory failure in a patient with myasthenia gravis? 1) NIF -15cm H2O 2) VC 10 mL/kg 3) PaCO243 mm Hg 4) pH 7.36

The Patient Interview

The Physical Examination and Its Basis in Physiology

Pulmonary Function Study Assessments

Arterial Blood Gas Assessments

Oxygenation Assessments

Cardiovascular System Assessments

Radiologic Examination of the Chest

Other Important Tests and Procedures

The Therapist-Driven Protocol Program and the Role of the Respiratory Therapist

Respiratory Failure and the Mechanical Ventilation Protocol

Recording Skills: The Basis for Data Collection, Organization, Assessment Skill

Chronic Obstructive Pulmonary Disease (COPD), Chronic Bronchitis, and Emphysema

Asthma

Bronchiectasis

Cystic Fibrosis

Pneumonia

Lung Abscess

Tuberculosis

Fungal Diseases of the Lung

Pulmonary Edema

Pulmonary Vascular Disease: Pulmonary Embolism and Pulmonary Hypertension

Flail Chest

Pneumothorax

Pleural Effusion and Empyema

Kyphoscoliosis

Interstitial Lung Diseases

Cancer of the Lung

Acute Respiratory Distress Syndrome

Guillain-Barré Syndrome

Sleep Apnea

Clinical Manifestations Common with Newborn and Early Childhood Respiratory Dis

Meconium Aspiration Syndrome

Transient Tachypnea of the Newborn

Respiratory Distress Syndrome

Pulmonary Air Leak Syndromes

Respiratory Syncytial Virus (Bronchiolitis or Pneumonitis)

Bronchopulmonary Dysplasia

Congenital Diaphragmatic Hernia

Congenital Heart Diseases

Croup Syndrome: Laryngotracheobronchitis and Acute Epiglottitis

Near Drowning/Wet Drowning

Smoke Inhalation, Thermal Injuries, and Carbon Monoxide Intoxication

Atelectasis

Filters

Which of the following values would be associated with impending ventilatory failure in a patient with myasthenia gravis? 1) NIF -15cm H₂O 2) VC 10 mL/kg 3) PaCO₂43 mm Hg 4) pH 7.36