Neurology: myasthenic crisis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: myasthenic crisis

Sample item

A myasthenic patient develops dyspnoea, weak cough and a falling forced vital capacity of 15 mL/kg after an infection. What is the right management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Admit to ICU, support ventilation and give IVIG or plasma exchange

Myasthenic crisis is respiratory failure from myasthenia, and needs ventilatory support with rapid immunotherapy using IVIG or plasma exchange. Offending drugs such as aminoglycosides, fluoroquinolones and magnesium are avoided. Cholinergic crisis from excess anticholinesterase should be considered but increasing the dose can worsen secretions.

Option by option

  • A. Admit to ICU, support ventilation and give IVIG or plasma exchange (correct)

    Correct. ICU support and IVIG or plasma exchange.

  • B. Increase pyridostigmine alone

    Escalating pyridostigmine alone is inadequate and can cause secretions.

  • C. Give neostigmine and discharge

    Discharge is unsafe with respiratory failure.

  • D. Give magnesium sulphate

    Magnesium worsens neuromuscular blockade.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Admit to ICU, support ventilation and give IVIG or plasma exchange. Myasthenic crisis is respiratory failure from myasthenia, and needs ventilatory support with rapid immunotherapy using IVIG or plasma exchange.

Why is "Increase pyridostigmine alone" not the answer?

Escalating pyridostigmine alone is inadequate and can cause secretions.

Why is "Give neostigmine and discharge" not the answer?

Discharge is unsafe with respiratory failure.

Why is "Give magnesium sulphate" not the answer?

Magnesium worsens neuromuscular blockade.

What concept does this question test?

It tests Neurology: myasthenic crisis in General Medicine. Offending drugs such as aminoglycosides, fluoroquinolones and magnesium are avoided. Cholinergic crisis from excess anticholinesterase should be considered but increasing the dose can worsen secretions.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: myasthenic crisis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.