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  #1  
Old 10-15-2015
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Default IM question of the day

A 37 year old women with myasthenia graves comes to the emergency department with a fever and cough productive of yellow green sputum. She has been on pyridostigmine for the past few months. The patient has been reluctant to have a thymectomy. Her temperature is 38.9C, blood pressure is 120/76mm Hg, pulse is 112/min, and respirations are 22/min. Pulse oximetry shows 86% oxygen saturation on room air but improves to 95% on 40% facets oxygen. Her respiratory effort is weak. There is a decline on serial measurement of vital capacity. Which of the following is the most appropriate next steps in management?
A. Atropine
B. Endotracheal intubation
C. Increase pyridostigmine dose
D. Intravenous immunoglobulin
E. Plasmapheresis
F. Prednisone

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  #2  
Old 10-15-2015
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Quote:
Originally Posted by ccake209 View Post
a 37 year old women with myasthenia graves comes to the emergency department with a fever and cough productive of yellow green sputum. She has been on pyridostigmine for the past few months. The patient has been reluctant to have a thymectomy. Her temperature is 38.9c, blood pressure is 120/76mm hg, pulse is 112/min, and respirations are 22/min. Pulse oximetry shows 86% oxygen saturation on room air but improves to 95% on 40% facets oxygen. Her respiratory effort is weak. There is a decline on serial measurement of vital capacity. Which of the following is the most appropriate next steps in management?
A. Atropine
b. Endotracheal intubation
c. Increase pyridostigmine dose
d. Intravenous immunoglobulin
e. Plasmapheresis
f. Prednisone

for more check out blog http://2ckquestions.tumblr.com
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  #3  
Old 10-15-2015
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Default answer is B

Answer is B
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  #4  
Old 10-17-2015
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Can someone please explain? Why B?
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  #5  
Old 01-18-2016
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Hey Hassan, tried messaging you but says your inbox is full. Do you have an email i can contact you on? Or perhaps you can inbox me, it says i cant respond until your inbox empties

Thanks so much!
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  #6  
Old 01-18-2016
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Elective intubation should be considered if serial measurements of the VC show values less than 20 mL/kg or if the MIF is worse than -30 cmH20. Ventilatory assistance should consist of endotracheal intubation with positive pressure mechanical ventilation.
Treat MG crisis with chronic immunomodulating therapy( prednisone , azathioprine , mycophenolate mofetil, or cyclosporine) and rapid therapy with plasmapheresis or IVIG .
Increasing dose of pyridostigmine wouldn't do much to AchAb, moreover it can worsen resp function due to increase in secretions.
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  #7  
Old 01-18-2016
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Thank you for the detailed explanation!
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  #8  
Old 01-18-2016
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Quote:
Originally Posted by step1rah View Post
Hey Hassan, tried messaging you but says your inbox is full. Do you have an email i can contact you on? Or perhaps you can inbox me, it says i cant respond until your inbox empties

Thanks so much!
Just messaged you
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