Which of the following is an early symptom of Myasthenia gravis?

AIIMS Rishikesh NO - 2019

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Rishikesh NO - 2019

Explanation

Myasthenia Gravis (MG) is an autoimmune disorder affecting the neuromuscular junction, leading to fatigable muscle weakness.
The most common initial presentation involves the extraocular muscles, which are responsible for eye and eyelid movement.
Ptosis (eyelid drooping) and diplopia (double vision) are the hallmark early symptoms of MG, occurring in over 50% of patients as the first sign.
Since both ptosis and diplopia are correct early symptoms, the option that encompasses both is the most complete and accurate answer.

Option A: Ataxia, or impaired coordination and balance, is a sign of cerebellar dysfunction. Myasthenia Gravis affects the neuromuscular junction and does not involve the cerebellum.
Option B: While ptosis is a correct early symptom of Myasthenia Gravis, this option is incomplete because diplopia is also a very common and characteristic early sign.
Option C: Similar to ptosis, while diplopia is a correct early symptom, this option is incomplete as ptosis is also a hallmark initial presentation of Myasthenia Gravis.

Clinical Relevance

Nursing practice connection: Knowing Early clinical manifestations of Myasthenia Gravis helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing ptosis and diplopia as early signs of MG is crucial for nurses to facilitate prompt diagnosis and treatment, preventing potential complications like aspiration or respiratory failure.
Nursing care for patients with MG includes scheduling activities to conserve energy, providing rest periods, and administering medications (like anticholinesterases) on a strict schedule to maintain muscle strength.
For diplopia, an eye patch (alternating eyes) can be used to relieve double vision. For ptosis, special glasses with a 'ptosis crutch' may be helpful.

How to Approach the Question

First, identify the core of the question, which is asking for the 'early symptom' of 'Myasthenia Gravis'.
Recall the pathophysiology of MG: it's an autoimmune attack on acetylcholine receptors at the neuromuscular junction, causing muscle weakness.
Consider which muscle groups are most commonly affected first. The small, frequently used muscles of the eyes and eyelids are classic initial targets.
Evaluate each option: 'Ataxia' is related to coordination (cerebellum), not MG. 'Ptosis' (eyelid drooping) is a classic sign. 'Diplopia' (double vision) is also a classic sign.
Notice that both B and C are correct. When multiple options seem correct, look for a composite option that includes them. Option D combines both B and C.
Conclude that the most comprehensive and accurate answer is the one that includes both major early symptoms.

Concept Tested & Keywords

QIY56CU-j_IecA43FDuZPo

E6 Medicine Davidson Principles Practice 24e p. 1161-1163

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1665-1667