A 54-year-old woman with generalized myasthenia gravis is admitted with pneumonia. Over three hours she develops dysphagia, a weak cough, pooling

Question

A 54-year-old woman with generalized myasthenia gravis is admitted with pneumonia. Over three hours she develops dysphagia, a weak cough, pooling secretions, paradoxical abdominal breathing, and inability to count beyond eight on one breath. Forced vital capacity falls from 24 to 14 mL/kg and negative inspiratory force is -18 cm H2O. Oxygen saturation is 96% on room air and arterial PCO2 is normal. What is the most appropriate immediate plan?

Accepted Answer

Urgently involve ICU and airway teams for controlled ventilatory support, treat the pneumonia, and start plasma exchange or intravenous immunoglobulin with neurology

Answer

Continue antibiotics with supplemental oxygen and repeat blood gases, because normal saturation and carbon dioxide make immediate ventilatory support unnecessary

Answer

Transfer her to ICU for serial respiratory testing, increase pyridostigmine to treat the bulbar weakness, and defer intubation and rescue immunotherapy until vital capacity falls below 10 mL/kg

Answer

Intubate for airway protection and treat the pneumonia, but defer plasma exchange or intravenous immunoglobulin until the infection has resolved

Answer

Start noninvasive ventilation despite the secretion burden, give high-dose corticosteroid as sole rescue therapy, and intubate only if hypercapnia develops

Severe hyperkalaemia — MCCQE Part 1 MCQ