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Myasthenic crisis — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsMyasthenic crisisSCE Acute Medicine

A 42-year-old man presents with acute neurological symptoms. Relevant history includes vascular, infectious or neuromuscular risk factors. On assessment, neurological examination shows focal or global dysfunction. Investigations show bulbar weakness, low FVC and rising PaCO2 after ciprofloxacin. What is the most appropriate next step in management?

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Correct answer: C — Arrange urgent critical care admission with IVIG or plasma exchange planning

The key discriminator is that bulbar weakness, low FVC and rising PaCO2 after ciprofloxacin, which makes Arrange urgent critical care admission with IVIG or plasma exchange planning the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Start broad-spectrum intravenous antibiotics and Give analgesia and antiemetic therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: ABN myasthenia guidance