All right, welcome to episode 597 of the Divine Intervention Podcast.

Into this podcast, we're going to be finishing the Free 120 series for Step 1.

Let's start with question 11.

It says a 34-year-old woman with myasthenia gravis comes to the ED because of a two-day

history of increasing weakness, shortness or breath, and abdominal cramping.

Cream medications are prednisone and pyrido stigma.

If you look at her vitals, she is bradycardic.

Her respirations are high and shallow.

So she's breathing at 25 per minute and her respirations are shallow.

Her voice is soft and hyperneasal and she coughs weakly when swallowing water.

Breath and heart sounds are normal.

Pulmonary testing shows inability to generate a normal negative inspiratory force during forced inspiration.

The abdomen is soft and non-tender with increased bowel sounds.

Muscle strength is 4 out of 5 diffusely, with severe, continuous and diffuse fasciculations.

Deep tendon reflexes are sluggish but symmetric.

Which of the following is the most likely cause of this patient's weakness?

So we see this person has a history of myasthenia gravis, and she's being treated

properly.

You know, she's on steroids, and she's on pyridostigmine.

Remember, in myasthenia gravis, you make auto antibodies against the nicotinic acetylcholine

receptor.

So that's why she's taking pyridostigmine. It's an acetylcholine receptor. So that's why she's taking pyrido stigmin.

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