Question 127

You are called to the emergency room to evaluate a patient with acute onset bilateral ptosis. You note significant bilateral upper eyelid ptosis, minimally reactive pupils and diffuse bilateral ophthalmoplegia. On systemic examination she has diffuse muscular weakness. No h/o trauma, pain or proptosis and no recent illnesses. Which history is most consistent with this underlying diagnosis?

Recently got a new pet turtle

Ate nacho cheese from a gas station

Got a cat scratch last week

Exposure to insecticides

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