A 54-Year-Old Man Comes to the Office Due to Seeing

question 370

Multiple Choice

A 54-year-old man comes to the office due to seeing double while watching TV at night.  The sensation resolves when he closes either eye.  The patient gets a mild headache when he experiences double vision but has no associated nausea, vomiting, photophobia, or phonophobia.  According to his wife, his voice gets a little "nasal" in the evening.  He has no other medical problems and does not use tobacco, alcohol, or illicit drugs.
The patient's vital signs are normal.  His eyes are shown in the image below.  Eye movements are full, and pupils are equal and equally reactive to light with a brisk response.  Funduscopic examination is normal.  There is no extremity weakness or sensory loss.  He is stable in the Romberg position.  The remainder of the physical examination is normal.

Which of the following is the best next step in management of this patient?

• A)Autoantibody testing
• B)CT scan of the chest
• C)Edrophonium test
• D)Prednisone therapy
• E)Pyridostigmine therapy

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Definitions:

Differences

Variations or disparities among individuals, objects, ideas, or phenomena, highlighting diversity or distinction.

Avoid Conflict

The practice or strategy of preventing or minimizing disputes, disagreements, or confrontations.

Positive Thinking

A mental attitude focusing on optimism and constructive outcomes, which can influence one's stress level and overall health.

Conflict Resolution

The process of resolving disputes or conflicts through communication, negotiation, or other means.