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regards



DR KUNAL MAHAJAN



mbbs(rpgmc tanda)

md med student(pgims rohtak)









Friday, April 9, 2010

myasthenia gravis most sensitive test????

hey guys,,,if you see ques 185 allindia 2005 mudit khanna writes edrophonium test
which is wrong.
edrophonium test has low sensitivity and harrison writes that it is used infrequently to diagnose MG and is limited to situations when other investigations do not yield a conclusive diagnosis.
harrison writes that single fibre EMG is the confirmatory test but specificity is low.If you search for the most sensitive investigation for MG on google books and sites like wikipedia,,you will find its SINGLE FIBRE EMG which is most sensitive.
so please change the answer in allindia 2005 mudit khanna paper
i thank dr.varun agarwal who gathered the following material in support of all this:

reference no 1) http://neuromuscular.wustl.edu/mtime/mgdx.html
it writes few things against edrophonium test(also k/a tensilon test),,,just check out
Utility of Tensilon test
Only useful in patients with objective, preferably measurable, findings on physical examination
Rarely helpful in the diagnostic evaluation of equivocal cases of MG
Sensitivity for MG is relatively low (60%) compared to other diagnostic t
ests
and few things in favour of SFEMG from the same site
SFEMG is the most sensitive test for MG
Sensitivity: > 95% positive in generalized & ocular MG


reference no.2) - http://en.wikipedia.org/wiki/Myasthenia_gravis
read the lines from wikipedia:

''The "edrophonium test" is infrequently performed to identify MG; its application is limited to the situation when other investigations do not yield a conclusive diagnosis ...
Its single fiber electromyography, which is considered to be the most sensitive (although not the most specific) test for MG
.''


i have got more material to prove the above written facts,,,you can safely mark as according to the following statements in the exam:
1) most sensitive investigation for MG = single fibre EMG
2)most specific investigation for MG = anti Ach receptor antibodies



please comment if you have doubts on this

1 comment:

  1. help me 4r aiims may 2009 Q NO. 194 n 196... q no.194 every source says diff... such as rxpg... very very imp Q

    ReplyDelete