Muscle relaxants: Eaton-Lambert syndrome: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Muscle relaxants: Eaton-Lambert syndrome

Sample item

A patient with small-cell lung cancer has proximal muscle weakness that improves with repeated effort. How will the patient respond to neuromuscular blocking drugs?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Sensitive to both depolarising and non-depolarising drugs

Lambert-Eaton syndrome is caused by antibodies against presynaptic voltage-gated calcium channels, which reduces acetylcholine release. The patients are unusually sensitive to both depolarising and non-depolarising relaxants and respond poorly to anticholinesterases. Strength improves transiently with repeated effort or stimulation.

Option by option

  • A. Resistant to non-depolarising drugs

    Resistance to non-depolarising drugs is not a feature of the syndrome.

  • B. Sensitive to non-depolarising and resistant to depolarising drugs

    Patients are not resistant to suxamethonium in this syndrome, in contrast to myasthenia gravis.

  • C. Normal sensitivity to all relaxants

    Sensitivity is clearly increased and not normal.

  • D. Sensitive to both depolarising and non-depolarising drugs (correct)

    Correct. Reduced acetylcholine release makes patients sensitive to both groups.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Sensitive to both depolarising and non-depolarising drugs. Lambert-Eaton syndrome is caused by antibodies against presynaptic voltage-gated calcium channels, which reduces acetylcholine release.

Why is "Resistant to non-depolarising drugs" not the answer?

Resistance to non-depolarising drugs is not a feature of the syndrome.

Why is "Sensitive to non-depolarising and resistant to depolarising drugs" not the answer?

Patients are not resistant to suxamethonium in this syndrome, in contrast to myasthenia gravis.

Why is "Normal sensitivity to all relaxants" not the answer?

Sensitivity is clearly increased and not normal.

What concept does this question test?

It tests Muscle relaxants: Eaton-Lambert syndrome in Anaesthesia. The patients are unusually sensitive to both depolarising and non-depolarising relaxants and respond poorly to anticholinesterases. Strength improves transiently with repeated effort or stimulation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Muscle relaxants: Eaton-Lambert syndrome?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.