Which of the following is a common presenting sign of myasthenia gravis?

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Multiple Choice

Which of the following is a common presenting sign of myasthenia gravis?

Fatigable weakness of voluntary muscles, especially around the eyes, is the hallmark of myasthenia gravis. Ptosis occurs because the eyelid elevator (levator palpebrae superioris) becomes weak and fatigues with use, so the drooping eyelids are a common early presenting sign. The key feature is that weakness fluctuates with activity and improves with rest, so patients may notice their eyelids look fine after a nap but appear droopy after active use or toward the end of the day. This pattern helps distinguish MG from other conditions. Hyperreflexia would point away from MG because reflexes are typically normal or decreased in NMJ disorders, not increased. Severe chronic cough or hypertension are not characteristic presenting signs of MG and don’t reflect the fluctuating fatigable NMJ weakness seen in MG.

Fatigable weakness of voluntary muscles, especially around the eyes, is the hallmark of myasthenia gravis. Ptosis occurs because the eyelid elevator (levator palpebrae superioris) becomes weak and fatigues with use, so the drooping eyelids are a common early presenting sign. The key feature is that weakness fluctuates with activity and improves with rest, so patients may notice their eyelids look fine after a nap but appear droopy after active use or toward the end of the day. This pattern helps distinguish MG from other conditions.

Hyperreflexia would point away from MG because reflexes are typically normal or decreased in NMJ disorders, not increased. Severe chronic cough or hypertension are not characteristic presenting signs of MG and don’t reflect the fluctuating fatigable NMJ weakness seen in MG.

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