A 35-year-old woman presents to the clinic with a chief complaint of double vision. She reports…

A 35-year-old woman presents to the clinic with a chief
complaint of double vision. She reports intermittent and progressively
worsening double vision for approximately 2 months, rarely at first but now
every day. She works as a computer programmer, and the symptoms increase the
longer she stares at the computer screen. She has also noted a drooping of her
eyelids, which seems to worsen with prolonged working at the screen. Both
symptoms subside with rest. She is generally fatigued but has noted no other
weakness or neurologic symptoms. Her medical history is unremarkable. Physical
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A 35-year-old woman presents to the clinic with a chief
complaint of double vision. She reports intermittent and progressively
worsening double vision for approximately 2 months, rarely at first but now
every day. She works as a computer programmer, and the symptoms increase the
longer she stares at the computer screen. She has also noted a drooping of her
eyelids, which seems to worsen with prolonged working at the screen. Both
symptoms subside with rest. She is generally fatigued but has noted no other
weakness or neurologic symptoms. Her medical history is unremarkable. Physical
examination is notable only for the neurologic findings. Cranial nerve
examination discloses impaired lateral movement of the right eye and bilateral
ptosis, which worsen with repetitive eye movements. Motor, sensory, and reflex
examinations are otherwise unremarkable.

Questions

A. What is the likely diagnosis? What is the pathogenesis of
this disease?

B. What other neurologic manifestations might you expect to
see?

C. What is the mechanism by which this patient’s ocular
muscle weakness increases with prolonged activity?

D. What associated conditions should be investigated in this
patient?

E. What treatments should be considered?

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