Muscle Extra Credit -OL -Saved to this PC Layout References Mailings Review View
ID: 3514694 • Letter: M
Question
Muscle Extra Credit -OL -Saved to this PC Layout References Mailings Review View Help Tel me what you want to do Jill a 25-year-old gymnastics instructor presents with complaints of muscle weakness in her face that comes and goes. Her symptoms have been getting progressively worse over the past couple of months. She complains her jaw gets tired as she chews and swallowing is more difficult. She also notes some double vision occurs late in the evening, especially after reading for a bit. At work, it has become more difficult to assist her young gymnasts because of upper arm weakness. On physical examination, she has notable ptosis (drooping) of both eyelids after repeated blinking exercises. Electromyography reveals progressive weakness and decreased amplitude of contraction of the distal arm muscles upon repeated mild shocks of the ulnar and median nerves. Both her symptoms and electromyography findings reversed within 40 seconds of intravenous administration of an acetylcholinesterase inhibitor. Blood tests reveal high levels of an anti- acetylcholine receptor antibody in her plasma. Jill's treatment includes a long-lasting anticholinesterase drug (acetylcholinesterase inhibitor) and prednisone, a corticosteroid. She likely will also undergo occasional plasmapheresis when her symptoms become especially severe. Answer each question in complete sentences 1. How are the antibodies to the acetylcholine receptors interfering with Jill's skeletal muscle function? 2. What is acetylcholinesterase and how does an acetylcholinesterase inhibitor act to improve Jil's skeletal muscle function? 3. What is the reason for plasmapheresis? What will it accomplish? 4. What condition might Jill be suffering from? Explain.Explanation / Answer
Answer 1. In autoimmune disease there are antibodies formed against some body normal antigen. There are two types of antibodies interfering with acetylcholine receptors namely anti acetylcholine receptor and anti muscle specific tyrosine kinase.
Answer 2. Acetylcholinsterase is enzymes which causes the metabolism of acetylcholine at neuromuscular junction. Antibodies are also metabolising acetylcholine in this given scenario. So acetylcholinsterase inhibitor can help in the given disease in the question.
Answer 3. Plasmapheresis is used to remove antibodies from the circulation. The Intravenous immunoglobulin is used in Plasmapheresis binds to circulating antibodies and then remove them. This is the reason why Plasmapheresis is helpful in this given scenario.
Answer 4. Jill is suffering from myasthenia gravis. All the signs and symptoms given in the case is suggestive of myasthenia gravis. All the treatment given also indicates the diagnosis of myasthenia gravis. It is progressive disease causing muscle weakness due to its autoimmune nature. It is acquired hereditary. Antibodies are formed against acetylcholine and causing sign and symptoms given.
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