Approach to differentiating lesions (neuromuscular junction) Quiz: Ace Your Exams
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A 41-year-old woman presents to the emergency department for evaluation of worsening weakness for the past two months. She has noted difficulty brushing her hair, rising from a chair, and has occasionally choked while eating dinner. Additionally, her eyelids have appeared droopy while applying her makeup for the past week. This morning, she developed double vision and slurred speech. Past medical history is noncontributory, and she takes no regular medication. Her temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 14/min, and blood pressure is 118/78 mmHg. On exam, she appears alert with hypophonic speech. She has bilateral ptosis, neck flexor weakness, and weakness of the bilateral shoulder abductors and hip flexors. Sensation is intact. What is the most appropriate next step in evaluation?
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