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Old 03-28-2012
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Question Myasthenia Gravis; What's the next step

A 45-year-old woman with a 6-month history of diplopia, which gets worse as the day goes by, presents at the emergency room (ER). She has also been feeling weaker in the evenings for the last couple of months. A week ago, she started getting short of breath and ran low fevers, and her primary care physician (PCP) prescribed an aminoglycoside antibiotic. A couple of days later, the shortness of breath got worse, and she became so weak that she had to call off work. Her vital signs are as follows: temperature (T), 37C (98.7F); blood pressure (BP), 120/85 mm Hg; heart rate (HR), 105 beats/minute; respiration rate (RR), 28 breaths/minute; vital capacity (VC), 700 mL; negative inspiratory force (NIF), -20 mm Hg. Her voice is shallow. She has labored breathing. She has 3 mm bilateral ptosis, and her pupils are equal and reactive. The neck flexion strength is 3/5. Her motor strength is 4/5 in all extremities, worse proximally. Her reflexes are normal, and sensation is intact. What is the most appropriate next step?

A. Administer intravenous immunoglobulin (IVIg)
B. Administer oral prednisone
C. Elective intubation
D. Order anti-acetylcholine receptor antibody levels
E. Order chest computed tomography (CT)
F. Order Tensilon test
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Old 03-28-2012
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C. Elective intubation - to protect airways?
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Old 03-28-2012
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ans.C elective intubate
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Quote:
Originally Posted by usmlepak View Post
ans.C elective intubate
whats ur reason?
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Old 03-28-2012
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RR=28, labored breathing => intubation?
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Old 03-28-2012
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C.
Intubation and intensive care unit (ICU) transfer usually are reserved for patients in myasthenic crisis with respiratory failure. Rapid respiratory failure may occur if the patient is not monitored properly. Patients should be watched very carefully, especially during exacerbation, by measuring negative inspiratory force and vital capacity.
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Old 03-29-2012
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Quote:
Originally Posted by um aala View Post
C.
Intubation and intensive care unit (ICU) transfer usually are reserved for patients in myasthenic crisis with respiratory failure. Rapid respiratory failure may occur if the patient is not monitored properly. Patients should be watched very carefully, especially during exacerbation, by measuring negative inspiratory force and vital capacity.
just to add
NIF[ negative inspiratory force] > 70 is normal , 20 or less is criteria for intubation in MG !!

also, normal vital capacity is 3-5 litres..so this patient has pretty low VC.

ans is intubation
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Emergency-Medicine, Internal-Medicine-, Neurology-, Step-2-Questions

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