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Myasthenic crisis — RCPSC IM MCQ

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HardNeurologyMyasthenic crisisRCPSC IM

A patient with myasthenia gravis develops pneumonia, dysphagia, weak cough, declining vital capacity and rising PaCO2. Which management is required?

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Correct answer: E — Start ICU ventilatory support plus IVIG or plasma exchange

The best answer is “Start ICU ventilatory support plus IVIG or plasma exchange”. Bulbar weakness, ventilatory decline and hypercapnia indicate myasthenic crisis. Airway planning and rapid immunomodulation are required; magnesium and beta blockers may worsen weakness, and antibody testing must not delay treatment. Serial vital capacity, inspiratory force, bulbar function and blood gases guide intubation timing because oxygen saturation may remain reassuring until respiratory reserve is critically reduced.

Reference: International consensus guidance for management of myasthenia gravis, full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC7884987/