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Myasthenic crisis — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsMyasthenic crisisSCE Acute Medicine

A 62-year-old woman is assessed on the acute medical unit. She has myasthenia gravis and pneumonia. She is weak, cannot count beyond 8 on one breath and has bulbar symptoms. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: E — Request urgent senior critical care review

Request urgent senior critical care review is the best answer because bulbar weakness and reduced respiratory reserve in myasthenia indicate impending ventilatory failure. Give vitamin K and prothrombin complex concentrate is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Infection commonly precipitates myasthenic crisis.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-39-1