skip to main content

Myasthenic crisis — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute Neurological PresentationsMyasthenic crisisSCE Acute Medicine

A 66-year-old woman with myasthenia gravis presents with dysphagia, nasal speech and increasing breathlessness after a chest infection. Single-breath count is 8 and FVC is falling. Pupils are normal and she has fatigable ptosis. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Arrange ventilatory assessment and begin IVIg or plasma exchange

Bulbar weakness and falling FVC indicate impending myasthenic crisis. Urgent critical-care respiratory assessment is required, with early IVIg or plasma exchange and treatment of the precipitant. Aminoglycosides can worsen neuromuscular transmission; escalating oral pyridostigmine cannot substitute for airway planning.

Reference: https://www.nhs.uk/conditions/myasthenia-gravis/treatment/