American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be initiated before glucocorticoid treatment in patients with severe Myasthenia Gravis symptoms?

1. Plasmapheresis

2. Higher-dose glucocorticoids

3. Electromyography

4. Long-term antibiotics

The correct answer is: Plasmapheresis

In the management of severe Myasthenia Gravis symptoms, initiating plasmapheresis before glucocorticoid treatment is crucial due to the need for rapid symptom relief. Myasthenia Gravis can lead to a life-threatening condition known myasthenic crisis, characterized by respiratory failure due to muscle weakness. Plasmapheresis is an effective treatment option to remove circulating antibodies that interfere with neuromuscular transmission and exacerbate the symptoms, providing a quick alleviation of disease severity. Glucocorticoids take time to exert their effects, often several weeks, as they work by modulating the immune response and reducing the production of antibodies. Therefore, when immediate symptom control is necessary, especially in cases that could quickly progress to crises, plasmapheresis offers a more timely intervention. Other strategies, such as administering higher doses of glucocorticoids, may later be part of the long-term management plan, but they do not provide the rapid response that plasmapheresis offers in acute situations. Electromyography is primarily a diagnostic tool rather than a treatment and would not precede glucocorticoid therapy in acute management. Similarly, long-term antibiotics do not support the immediate treatment of Myas