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Myasthenic respiratory crisis — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsMyasthenic respiratory crisisSCE Acute Medicine

A 34-year-old woman presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show bulbar weakness with FVC 12 mL/kg and weak cough. What is the most appropriate next step in management?

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Correct answer: C — Admit to critical care for ventilatory support and rescue immunotherapy

The key discriminator is that bulbar weakness with FVC 12 mL/kg and weak cough, which makes Admit to critical care for ventilatory support and rescue immunotherapy the single best answer. Start broad-spectrum intravenous antibiotics is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy and Provide supportive care and close monitoring 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