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This 14-year-old boy was noted by his parents to develop drooping of the lids about 7 months ago. The amount of ptosis varies. He was in good health prior to the onset.

1.	A most likely diagnosis in this case is:
	a. thyroid ophthalmopathy b. double elevator palsy c. blepharophimosis triad d. myasthenia e. chronic progressive external ophthalmoplegia
2.	The following is a diagnostic test or sign for this condition:
	a. asking the child to look up for 30 seconds b. the Cogan twitch c. applying ice to the lids for 2-5 minutes d. intramuscular injection of prostigmine e. all of the above
3.	To better arrive at the diagnosis in this case, the examiner should also look for:
	a. ocular motility b. color vision c. corneal sensitivity d. atrophy of the distal third of the tongue e. all of the above

For answers to the above, click here on or after September 13, 2011.