A 42 year old male presents with a complaint of double vision and eyelid drooping for the past two to three months. Further questioning reveals that he also has developed recent increased fatigability and weakness in the evening and that the double vision and droopy eyes occurs while watching television and reading. Physical exam reveals bilateral ptosis accentuated by repetitive blinking. He has normal motor strength with a normal sensory exam and extraocular muscles are intact. There is no peri-orbital edema or exopththalmus present.

  1. If you were to order a CT or MRI scan of the head, neck, and thorax, what might you expect to find?
  1. A hypotholamic neoplastic process involving optic nerve
  2. A brain stem neoplastic arocess involving cranial nerves
  3. Evidence of Hashimoto’s Disease with suggestion of hypothyroidism
  4. A mediastinal mass
  5. Normal CT and MRI scans

 

2. Which of the following laboratory tests would be most beneficial in the diagnosis of this disease?

    1. Serum calcium, potassium, glucose, and CPK
    2. Anti-Histidyl-t-RNA synthetase (anti-Jo-1)
    3. Acetylcholine receptor antibody
    4. SS-A and SS-B
    5. Thyroid function studies

 

3. What results would you expect if you gave this patient a Tensilon Test?

    1. Resolution of the ptosis and diplopia
    2. Resolution of the weakness and fatigability
    3. No resolution of the ptosis and diplopia
    4. No resolution of the weakness and fatigability
    5. Ptosis and diplopia become worse

 

4. Which of the following statements is/are true regarding thyrotoxic myopathy?

    1. It usually presents with proximal muscle weakness
    2. It may cause diplopia
    3. Hypokalemia may occur with weakness
    4. Incidence in males is greater than females
    5. All of the above

 

5. Which of the following statements regarding myasthenia gravis is/are true?

    1. It affects young women more commonly than young men, but the incidence is equal in older adults
    2. Thymic hyperplasia is found in approximately two-thirds of the patients with myasthemis growth
    3. Thymomas may be found in 10-15 percent of patients
    4. Treatment includes anticholinestrase drugs, steroids, plasmapheresis, and resection of thymoma if present
    5. All of the above

 

6. The most likely diagnosis of a 55 year old alcoholic male patient presenting with ptosis, diplopia, easy fatigability, weakness, negative acetylcholine receptor antibody, normal TSH with a Tensilon test demonstrating no clinical improvement and a CT-scan of chest revealing a peri-hilar mass would be?

    1. Myasthenia Gravis
    2. Thyrotoxic myopathy
    3. Lambert-Eaton myasthenic syndrome
    4. Ethanol myopathy
    5. None of the above

 

  1. Lambert-Eaton myasthenic syndrome is most commonly associated with which of the following?
  1. Small cell undifferentiated carcinoma of the lung
  2. Thymoma
  3. Papillary and follicular carcinoma of thyroid
  4. Rhabdomyolysis due to binge drinking
  5. Botulism