A 33-year-old female complains of episodes of weakness of the left side of the face and double vision. Drooping of the left eyelid and weakness of the jaw muscle develops gradually throughout the day, and it is worse at night than the morning. The patient has a medical-surgical history of cholecystectomy at age 30. Otherwise, the patient has no history of illness and takes no medications. She denies use of tobacco or alcohol. On physical examination, vital signs are: temperature 98°F, respirations 18 breaths/min, pulse 66 beats/min, and blood pressure 110/60. Ptosis of the left eyelid is noted. Vision: 20/20 os, 20/20 od, and 20/20 ou. Heart: regular rate and rhythm, no murmurs. Lungs are clear to auscultation. Abdomen is nontender with no organomegaly. Extremities: skin is pink, cool to touch, and intact bilaterally. Left and right quadriceps muscle strength 5/5. Deep tendon reflexes left and right +2/4. No clonus. Negative Homan's and Babinski's signs. Sensation to pinprick and cotton ball intact in extremities and equal bilaterally. Dorsalis pedis pulses +1/4 bilaterally. Eyelids: left-sided ptosis. No facial droop. Left and right cheek sensation to pinprick and cotton ball intact. Masseter muscle: 2/5 on left versus 5/5 on right. Extraocular muscles intact. Gag reflex: uvula midline gag intact. Shrug and sternocleidomastoid muscle strength 5/5 bilaterally. Tongue: midline and strength 5/5 bilaterally. The following disorder(s) should be considered in the diagnosis:

Question

Quizplus · Accepted Answer

The patient's symptoms of fluctuating muscle weakness that worsens throughout the day, particularly affecting the eyelid (ptosis) and jaw muscle, are characteristic of myasthenia gravis. This autoimmune disorder affects the neuromuscular junction, leading to muscle fatigue and weakness.

A 33-Year-Old Female Complains of Episodes of Weakness of the Left