The Master Surgeon | Free Multiple Choice Questions (MCQs)

QUESTION NO

212

A 49 years old female complains of tiredness and double vision which is worse at the end of the day. She also reports having droopy eyelids and general muscle weakness. This improves with rest and the severity of her symptoms is variable. She denies any issues with breathing or swallowing. She has a family history of Graves disease. She has no past medical history of note and is not on any medications. She is a non smoker. On examination, there is bilateral ptosis. She complains of diplopia which affects her right eye more than her left. Her pupils are equal and reactive. When asked to start counting, her voice becomes quieter and quieter. What is the most appropriate initial investigation?

Please select one of the following:

CT thymus
Anti MuSK (muscle specific tyrosine kinase) antibody levels
Anti AChR (acetylcholine receptor) antibody levels
Tensilon test
Neurophysiological assessment

Question By Dr Ley Taing Chan MBBS, BA.