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Paper I — 2025 March (Supplementary) (2010 Scheme) — Q2

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Paper I
2025 March (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

A man aged 45 years presented with complaints of gradual onset double vision, drooping eyelids, difficulty in chewing food and weakness of limbs which is accentuated by exercise. The symptoms fluctuate in intensity over time. A provisional diagnosis of Myasthenia gravis is made.

  • (a) Can a pharmacological test be performed to confirm the diagnosis. Explain 2 mark(s)
  • (b) What are the medications used to treat Myasthenia gravis 3 mark(s)
  • (c) Is there a surgical solution for this illness 1 mark(s)
Q26 marksEssays

Answer

a) Pharmacological confirmatory test Yes — the edrophonium (Tensilon) test. IV edrophonium, a very short-acting anticholinesterase, produces dramatic, brief improvement in muscle power specifically in myasthenia gravis (by transiently raising acetylcholine availability at the neuromuscular junction), distinguishing it from other causes of similar weakness. Circulating anti-acetylcholine-receptor antibodies can also be demonstrated serologically.

b) Medications used

  • Anticholinesterases — pyridostigmine (preferred, longer-acting) or neostigmine — first-line symptomatic therapy, allowing the same acetylcholine to interact repeatedly with the reduced pool of available receptors.
  • Corticosteroids and immunosuppressants (azathioprine, cyclosporine) — suppress antibody production directly, used for induction and maintenance of remission.
  • IV immunoglobulin or plasmapheresis — for acute exacerbations/myasthenic crisis, providing rapid but temporary improvement.

c) Surgical solution Yes — thymectomy is generally advised, particularly with a thymoma or in younger patients. The thymus is thought to harbour the antigenic source driving antibody production, and thymectomy can produce gradual improvement or even complete remission.

  1. 1Cholinergic System

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  2. 2(2023 July (Supplementary) (2019 Scheme)Short Essay · 8 marks
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  13. 13Pharmacological basis for the use of Timolol in glaucoma.2024 June (Supplementary) (2019 Scheme)Short Answer · 4 marks
  14. 14Pharmacological management of Myasthenia gravis.2022 July (Supplementary) (2019 Scheme)Short Answer · 4 marks
  15. 15Treatment of organophosphorus poisoning2013 September (Supplementary) (2010 Scheme)Short Note · 3 marks
  16. 16Drug treatment of anti cholinesterase poisoning2013 April (2010 Scheme)Short Note · 3 marks
  17. 17Neostigmine2021 December (Supplementary) (2010 Scheme)Short Note · 3 marks
  18. 18Treatment of organophosphorous poisoning2014 September (Supplementary) (2010 Scheme)Short Note · 3 marks
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  20. 20Therapeutic uses and adverse effects of atropine.2016 October (Supplementary) (2010 Scheme)Short Note · 3 marks
  21. 21Neostigmine.2017 August (Supplementary) (2010 Scheme)Short Note · 3 marks
  22. 22Edrophonium2018 February (2010 Scheme)Short Note · 3 marks
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  28. 28Anti- muscarinic drugs2017 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  29. 29Drugs used in myasthenia gravis.2016 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
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  34. 34Rationale for use of pilocarpine in glaucoma2018 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  35. 35Two uses and two adverse effects of atropine2014 March (2010 Scheme)Short Answer · 1 mark
  36. 36Rationale for use of physostigmine in atropine poisoning2015 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  37. 37Rationale for the use of glycopyrrolate in pre-anesthetic medication.2016 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
  38. 38Cholinesterase reactivators2015 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  39. 39Atropine as antisecretory agent2019 February (2010 Scheme)Short Answer · 1 mark
  40. 40The preferred first-line pharmacologic treatment for open-angle glaucoma is:2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  41. 41Used in treatment of acute congestive glaucoma2018 February (2010 Scheme)Short Answer · 1 mark
  42. 42Why is benzhexol used in the treatment of drug induced Parkinsonism.2018 February (2010 Scheme)Short Answer · 1 mark
  43. 43Drugs used in Myasthenia gravis2013 April (2010 Scheme)Short Answer · 1 mark
  44. 44Trihexyphenidyl in drug induced extrapyramidal syndrome2021 May (Supplementary) (2010 Scheme)Short Answer · 1 mark
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  46. 46Bronchodilators (of two different groups)2013 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  47. 47Vesico-selective anticholinergics2020 February (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  48. 48Levodopa in Drug induced parkinsonism. Name the following (Two examples for each): (5x1=5)2025 March (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
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  52. 52Anticholinesterases2024 August (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
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  58. 58Drugs used to treat Organophosphorus poisoning2022 February (2019 Scheme)Short Answer · 0.2 marks
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