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Myasthenia gravis — RACP Paediatrics MCQ

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ModerateNeurologyMyasthenia gravisRACP Paediatrics

A 10-year-old presents with acute onset fluctuating ptosis and diplopia that worsen throughout the day. Muscle power is initially normal but fatigues with repetitive testing. Deep tendon reflexes are normal. What is the most likely diagnosis?

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Correct answer: D — Myasthenia gravis

Fluctuating weakness with fatigability, particularly affecting ocular and bulbar muscles (ptosis, diplopia), that worsens with activity and improves with rest is characteristic of myasthenia gravis. Anti-AChR antibodies are positive in ~80% of children. Edrophonium (Tensilon) test or ice-pack test can support the diagnosis.

Reference: RCH Melbourne – 2023 – Acute Weakness CPG; RACP Paediatric Curriculum – Neurology