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NUC Cessation Catastrophe — SCE Infectious Diseases MCQ

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HardHepatitisNUC Cessation CatastropheSCE Infectious Diseases

After unlicensed cosmetic botulinum toxin abroad, a patient develops diplopia, dysphagia and descending symmetrical weakness. Respiratory function is deteriorating. What is the correct immediate sequence?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Obtain serum, contact UKHSA and give antitoxin without awaiting confirmation

Explanation lettering: C = shown as B · E = shown as C · B = shown as D · D = shown as E

A is correct. Botulinum antitoxin neutralises circulating toxin but cannot reverse toxin already bound at the neuromuscular junction, so treatment is time critical. UKHSA should be contacted immediately to coordinate antitoxin; serum is ideally collected before administration, but results must not delay treatment when clinical suspicion is strong. CSF findings and pyridostigmine do not establish or treat botulism, and respiratory monitoring with early ventilatory support is essential.

Reference: UKHSA: botulism clinical and public-health management: https://www.gov.uk/government/publications/botulism-clinical-and-public-health-management/botulism-clinical-and-public-health-management