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 Best of Five 3.1

 

   

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BOF :3.1

A 30-year-old female presents with diplopia and weakness of her upper limbs that increases towards evening. On examination there is demonstrable fatiguability, reflexes are normal. There is no sensory loss.

The patient is treated with pyridostigmine and there is resolution of her symptoms. She subsequently presents with increasing weakness that has begun to involve her limbs and she also has involvement of the muscles of respiration. There are no fasiculations, pulse rate is 90 beats per minute, pupils normal in size, equal and react to light and accommodation.

In this situation the best mode of treatment would be with:

a)      Steroids

b)      Steroids and azathioprine

c)      Atropine

d)      Edrophonium

e)      Plasma exchange

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