In a patient with myasthenia gravis, which factor puts them at risk for aspiration?

• A. Progressive weakness of the oropharyngeal muscles
• B. Increased gag reflex
• C. Hyperreflexia
• D. No risk of aspiration

Answer: (A)

In myasthenia gravis, weakness of the muscles used for swallowing and protecting the airway—especially the oropharyngeal (bulbar) muscles—greatly raises the risk of aspiration. The autoimmune disruption at the neuromuscular junction causes fatigable weakness, so as a meal progresses these muscles fatigue, making swallowing less effective and the cough reflex weaker. Food or saliva can then enter the airway, leading to aspiration.

If the gag reflex were increased, that would generally help protect the airway rather than predispose to aspiration. Hyperreflexia isn’t a typical feature of MG, which is a neuromuscular junction disorder rather than a central nervous system lesion. And saying there’s no risk of aspiration contradicts the known bulbar involvement in MG.