Approach to differentiating lesions (neuromuscular junction) Quiz: Ace Your Exams
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A 27-year-old woman is brought to the emergency department by emergency medical services for evaluation of lethargy. Her roommate found her slumped in her desk chair, poorly responsive, and ill-appearing. Past medical history is notable for major depressive disorder for which she inconsistently takes citalopram. Her temperature is 37.0°C (98.6°F), pulse is 60/min, respirations are 18/min, and blood pressure is 110/85 mmHg. On exam, she appears alert and endorses nausea and double vision. She has bilateral ptosis, dysarthria, diaphoresis, watery eyes, and drooling. She has difficulty getting out of bed after an episode of emesis and fecal incontinence. Her complete blood count (CBC) with differential, comprehensive metabolic profile (CMP), urine toxicology screen, and serum hCG are unremarkable. Which of the following additional diagnostic tests can help confirm the suspected diagnosis?
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