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Cholinergic Crisis — RACP Adult Medicine MCQ

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HardNeurologyCholinergic CrisisRACP Adult Medicine

A patient with myasthenia gravis and pneumonia has nasal speech, weak cough, pooling secretions and rapidly falling forced vital capacity, but no diarrhoea, miosis or fasciculations. What is the priority?

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Correct answer: E — Escalate respiratory monitoring and treat myasthenic crisis plus its precipitant

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

B is correct because bulbar failure, ineffective cough and falling vital capacity can precede abrupt ventilatory collapse; ICU airway planning and treatment of infection and crisis are urgent. C can worsen secretions and does not replace ventilatory support. D may provoke deterioration and should not delay resuscitation. E lacks muscarinic or nicotinic excess. A is unsafe because oxygen saturation may remain normal until late in pure ventilatory failure. Plasma exchange or IV immunoglobulin is selected with neurology.

Reference: Myasthenia Gravis Association of Australia, symptoms and crisis: https://www.myasthenia.org.au/background/symptoms/