Myasthenia gravis: The Daily PANCE Blueprint
A 35-year-old woman presents to your office with complaints of double vision and difficulty chewing and swallowing. She also reports that her eyelids seem to droop, especially toward the end of the day. On examination, you note bilateral ptosis and diplopia, which worsen with sustained upward gaze. Repetitive nerve stimulation test shows a decremental response. What is the most likely diagnosis?
A. Multiple Sclerosis
B. Guillain-Barré Syndrome
C. Myasthenia Gravis
D. Lambert-Eaton Myasthenic Syndrome
E. Bell's Palsy
Answer and topic summary
The answer is C. Myasthenia Gravis.
This patient has Myasthenia Gravis (MG), an autoimmune disorder characterized by weakness and fatigability of skeletal muscles. The hallmark of MG is fluctuating muscle weakness that worsens with repetitive use and improves with rest. Ocular symptoms, such as ptosis and diplopia, are often the initial manifestations. The decremental response on repetitive nerve stimulation is a diagnostic finding in MG.
Incorrect Answers:
A. Multiple Sclerosis – Typically presents with sensory disturbances and motor deficits, not fluctuating muscle weakness.
B. Guillain-Barré Syndrome – Characterized by ascending muscle weakness and areflexia, not localized to ocular muscles.
D. Lambert-Eaton Myasthenic Syndrome – Associated with proximal muscle weakness and autonomic symptoms, not primarily ocular.
E. Bell’s Palsy – Affects the facial nerve, causing unilateral facial weakness, not bilateral ptosis and diplopia.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Neurology ⇒ ⇒
Also covered as part of the Internal Medicine EOR topic lists
