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General Medicine · Neurology: myasthenia gravis
Sample itemA patient has fluctuating ptosis and diplopia that worsen late in the day, with normal sensation and pupils. Which diagnosis is most likely?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Myasthenia gravis
Myasthenia gravis causes fatigable weakness from impaired neuromuscular transmission, commonly affecting ocular, bulbar, and proximal muscles. Sensation and autonomic pupillary function are preserved.
Option by option
A. Horner syndrome
Horner syndrome causes ptosis with miosis and anhidrosis.
B. Multiple sclerosis
Multiple sclerosis can cause diplopia but not this characteristic fatigable pattern.
C. Bell palsy
Bell palsy causes a unilateral peripheral facial palsy, not fatigable diplopia.
D. Myasthenia gravis (correct)
Correct. Fluctuating fatigable ocular weakness is a classic presentation.
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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