Rosh Internal Medicine Boost Practice Exam

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What is the first line treatment for a patient with myasthenia gravis who tests positive for acetylcholine receptor antibodies?

Carbidopa/levodopa
Edrophonium
Plasmapheresis
Pyridostigmine

The correct answer is: Pyridostigmine

The first line treatment for a patient with myasthenia gravis who tests positive for acetylcholine receptor antibodies is pyridostigmine. Pyridostigmine is an acetylcholinesterase inhibitor that enhances neuromuscular transmission by preventing the breakdown of acetylcholine in the synaptic cleft. This leads to increased availability of acetylcholine at the neuromuscular junction, which helps improve muscle strength in patients with myasthenia gravis. In myasthenia gravis, there is a decrease in the number of functional acetylcholine receptors due to antibody-mediated destruction. By increasing the amount of acetylcholine present, pyridostigmine mitigates the symptoms associated with muscle weakness, making it a preferred initial treatment approach. Other treatments, such as plasmapheresis or intravenous immunoglobulin, may be reserved for more severe cases or myasthenic crises, but they do not serve as first-line therapies for chronic management. Edrophonium is primarily used for diagnostic purposes rather than for sustained treatment of myasthenia gravis. Carbidopa/levodopa is not relevant to this condition as it is used in the treatment of Parkinson's disease.