American Board of Internal Medicine (ABIM) Certification Practice Exam

Which therapy is often included in the management of myasthenic crisis due to its rapid action?

1. Oral acetylcholinesterase inhibitors

2. Intravenous immune globulin

3. Long-acting steroids

4. Thymectomy

The correct answer is: Intravenous immune globulin

In the context of managing a myasthenic crisis, intravenous immune globulin (IVIG) is favored due to its rapid therapeutic effects. Myasthenic crisis is a severe exacerbation of myasthenia gravis, resulting in respiratory failure and leading to an urgent need for treatment. IVIG works by modulating the immune response, reducing antibodies that block acetylcholine receptors, and subsequently improving neuromuscular transmission. The use of IVIG in this acute setting is well-supported by clinical practice and can quickly stabilize the patient's condition. This is critical, as the patient may require prompt intervention to restore respiratory function and avoid complications. In contrast, therapies such as oral acetylcholinesterase inhibitors may take longer to show effects, long-acting steroids require time for their immunosuppressive actions to take effect, and thymectomy is a surgical intervention that is not suitable for acute crisis management. Thus, intravenous immune globulin stands out as a vital option in quickly addressing the potentially life-threatening aspects of myasthenic crisis.