All of the following are possible MG symptoms EXCEPT:

• A. Drooping eyelids
• B. Double vision
• C. Difficulty swallowing
• D. Hypertension

Answer: (D)

This question hinges on recognizing which symptoms come from myasthenia gravis and which do not. Myasthenia gravis causes fatigable weakness of skeletal muscles due to impaired neuromuscular transmission. It most often starts with muscles that control the eyes and face, so drooping eyelids (ptosis) and double vision (diplopia) are common. Bulbar muscles, which control swallowing and speech, can also be affected, leading to difficulty swallowing.

Hypertension, however, is a cardiovascular condition and does not arise from the neuromuscular transmission problems seen in MG. It isn’t a typical feature of MG symptoms, so it is the statement that does not fit with MG.

In short, MG presents with ocular and bulbar weakness from fatigable skeletal muscle weakness, while hypertension is unrelated to MG.