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Myasthenic Crisis – Acute Management — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularMyasthenic Crisis – Acute ManagementSCE Neurology

A patient with generalised myasthenia gravis develops rapidly worsening dysphagia, a weak cough and a falling vital capacity during treatment for pneumonia. He is increasingly unable to clear secretions but is not yet intubated. What is the most appropriate immediate strategy?

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Correct answer: B — Escalate to critical care, monitor respiratory function serially and start urgent IVIg or plasma exchange

Bulbar dysfunction, ineffective cough, secretion retention and falling vital capacity indicate impending myasthenic crisis. Critical-care involvement and repeated respiratory measurements are urgent, with rapid immunomodulation using IVIg or plasma exchange. Increasing acetylcholinesterase inhibition may worsen secretions; corticosteroids alone act too slowly and can initially exacerbate weakness. Diagnostic edrophonium must not delay airway and respiratory support.

Reference: ABN myasthenia gravis guidelines: https://pn.bmj.com/content/25/5/422 and https://pn.bmj.com/content/15/3/199