Choose the Correct Diagnosis: Young Adult with Ophthalmic and Muscle Symptoms
An 8-question medium-difficulty multiple-choice quiz focused on diagnosing a 25-year-old woman with ophthalmoparesis, intermittent ptosis, and fatigable muscle weakness.
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Quiz Questions & Answers
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Question 1: Which diagnosis best fits fluctuating ptosis, generalized fatigable weakness, and ophthalmoparesis in a young adult?
Myasthenia gravis
Chronic progressive supranuclear palsy
Lambert-Eaton myasthenic syndrome
Progressive external ophthalmoplegia
Question 2: Which diagnostic test most directly confirms impaired neuromuscular transmission in suspected myasthenia gravis?
MRI brain with contrast
Nerve conduction velocity study
Edrophonium (Tensilon) or neostigmine test
Serum creatine kinase level
Question 3: Which antibody finding most supports a diagnosis of generalized myasthenia gravis?
Anti-acetylcholine receptor (AChR) antibodies
Anti-MuSK antibodies
Anti-GAD antibodies
Anti-dsDNA antibodies
Question 4: Which clinical feature helps distinguish myasthenia gravis from a primary muscle disease (myopathy)?
Fixed weakness without diurnal variation
Rapidly progressive distal sensory loss
Marked fatigability with repetitive use that improves with rest
Muscle pain and dark urine after exercise
Question 5: Which imaging study is recommended to evaluate a potentially associated thymic abnormality in suspected myasthenia gravis?
Head CT without contrast
Abdominal ultrasound
Chest CT scan
MRI of the cervical spine
Question 6: Which treatment provides rapid short-term improvement in severe myasthenic weakness or crisis?
Daily physical therapy alone
Plasmapheresis or intravenous immunoglobulin
Long-term oral corticosteroids only
Beta-blocker therapy
Question 7: Which clinical pitfall could lead to misdiagnosing ocular myasthenia gravis as a cranial nerve palsy?
Pain behind the eye resolving with NSAIDs
Intermittent and variable eye movement deficits that change over minutes to days
Marked sensory loss in the distribution of the trigeminal nerve
Presence of pupil asymmetry with light-near dissociation
Question 8: Which non-pharmacologic advice is most useful for patients with fatigable weakness from myasthenia gravis?
Only take over-the-counter supplements
Avoid all social activities
Increase high-intensity exercise without rest
Plan activities to avoid prolonged exertion and schedule rest periods