A 45-year-old woman presents to her general physician complaining of diplopia towards towards lateral gaze and drooping of left eye lid for the last 1 month. She has noticed difficulty in lifting heavy objects and also feel breathlessness while walking stairs. She has problems with chewing and swallowing. Her friends have noticed that her voice has become slower and softer , She has lost about 4-5 kg in weight in the past 6 months. She also feels pain in small joints particularly in morning The woman has had no significant previous medical illnesses. She lives with her husband and three children.
She is a non-smoker and nondrinkers, nondiabetic and nonhypertensive. She is taking no regular medication. Examinations: She looks well, and examination of the cardiovascular, respiratory and abdominal systems is normal. Left ptosis, diplopia on rt lateral gaze and also looking down. However…
