What would be the priority intervention in a patient who is suffering from myasthenia gravis?

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AIIMS NORCET 8 Prelims Memory Based Paper 2025

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Answer 1

Correct Answer: Respiratory depression

Rationale:

Myasthenia gravis is a chronic autoimmune neuromuscular disorder that leads to weakness in the skeletal muscles responsible for breathing and moving parts of the body, including the arms and legs. The priority intervention in a patient suffering from myasthenia gravis should focus on respiratory function because respiratory depression is the most life-threatening complication.
Respiratory depression occurs when the respiratory muscles, particularly the diaphragm and intercostal muscles, become weak and unable to sustain adequate ventilation. This can lead to hypoxia, carbon dioxide retention, and respiratory failure, which are medical emergencies.
Interventions include monitoring oxygen saturation, arterial blood gases, and respiratory rate. Immediate steps may involve oxygen supplementation, mechanical ventilation, or non-invasive positive pressure ventilation (NIPPV) in severe cases.
Patients may also require treatment with anticholinesterase medications, such as pyridostigmine, and corticosteroids or immunosuppressants to manage the underlying condition.
Clinicians must promptly recognize signs of respiratory distress, such as increased respiratory effort, use of accessory muscles, or cyanosis, and act swiftly to stabilize the patient.

Explanation of Other Options:

Rest between activity

Rationale: While rest between activities is essential for patients with myasthenia gravis to prevent fatigue, it is not the priority intervention in acute situations. Fatigue management is part of long-term care but does not address life-threatening complications like respiratory depression.

Descending weakness

Rationale: Myasthenia gravis typically causes weakness in muscles that control voluntary movements, starting with ocular muscles and progressing to other skeletal muscles. However, the term "descending weakness" is more commonly associated with conditions like botulism. While muscle weakness is a hallmark of myasthenia gravis, it is not the primary intervention focus compared to respiratory depression.

Flaccid paralysis

Rationale: Flaccid paralysis refers to the complete loss of muscle tone and voluntary muscle control, often seen in conditions like spinal cord injuries or Guillain-Barré syndrome. While myasthenia gravis can cause muscle weakness, it does not typically result in flaccid paralysis. Therefore, this option is not relevant to the priority intervention.

Conclusion:

Respiratory depression is the most critical concern in patients with myasthenia gravis, as it can rapidly lead to respiratory failure if not addressed promptly. Management of respiratory function is essential to prevent life-threatening complications. Other options, while important for overall care, do not address the immediate risk of respiratory compromise.