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Myasthenic crisis — RCPSC EM MCQ

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HardNeurological emergenciesMyasthenic crisisRCPSC EM

CTAS 1: A 64-year-old with myasthenia gravis has dysphagia and dyspnoea after pneumonia symptoms. Vitals are HR 116, RR 30, SpO2 92%. Negative inspiratory force is -14 cmH2O and forced vital capacity is 11 mL/kg. Exam shows ptosis and fatigable neck flexion. What is the most likely diagnosis?

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Correct answer: B — Myasthenic crisis

Bulbar weakness, fatigability and low respiratory mechanics in known myasthenia indicate myasthenic crisis. Early airway and ICU planning are essential.

Reference: Neuromuscular respiratory failure guidance; Royal College EM Objectives