Activity ID
8121Expires
July 22, 2024Format Type
Journal-basedCME Credit
1Fee
$30CME Provider: JAMA Ophthalmology
Description of CME Course
A 54-year-old man presented with a 3-day history of right ptosis and double vision. He was otherwise healthy and did not take any regular medications. Initially, he had horizontal diplopia on the first day that was worse at the end of the day, but this resolved when the right eyelid ptosis became complete. He denied any difficulty with his speech, swallowing, weakness, or sensory changes.
He presented to the emergency department, and the emergency department physician reported a normal neurological examination result apart from the right-sided ptosis and limited eye movements. He was referred to ophthalmology and had a visual acuity of 20/20 OU. Both pupils were equal sizes and reactive to light. He was found to only have a complete limitation of elevation of his right eye and a limitation of abduction in his left eye (Figure). He was orthophoric in primary position, and there were no eyelid twitches. Orbicularis oculi strength was reduced on both sides. A dilated fundus examination had normal results bilaterally. An initial neurological examination, including assessments of motor strength in the upper and lower extremities and reflexes and a sensory examination, had normal results.
Disclaimers
1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.
ABMS Member Board Approvals by Type
ABMS Lifelong Learning CME Activity
Allergy and Immunology
Anesthesiology
Colon and Rectal Surgery
Family Medicine
Medical Genetics and Genomics
Nuclear Medicine
Ophthalmology
Orthopaedic Surgery
Pathology
Physical Medicine and Rehabilitation
Plastic Surgery
Preventive Medicine
Psychiatry and Neurology
Radiology
Thoracic Surgery
Urology
Commercial Support?
NoNOTE: If a Member Board has not deemed this activity for MOC approval as an accredited CME activity, this activity may count toward an ABMS Member Board’s general CME requirement. Please refer directly to your Member Board’s MOC Part II Lifelong Learning and Self-Assessment Program Requirements.
Educational Objectives
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
Keywords
Clinical Challenge, Myasthenia Gravis, Neurology, Neuromuscular Diseases, Neuro-ophthalmology
Competencies
Medical Knowledge
CME Credit Type
AMA PRA Category 1 Credit
DOI
10.1001/jamaophthalmol.2021.0028