A 54-year-old woman comes to the emergency department due to d | Uworld | Step 2ck

A 54-year-old woman comes to the emergency department due to double vision and a droopy eyelid. The patient began seeing 2 side-by-side images while watching television last night She attributed the symptoms to tiredness and went to bed. The vision disturbance was persistent on wakinq up today, and the patient also found her right eyelid was drooping. The diplopia is worse when looking toward the left and is not associated with headache, nausea, dizziness, or focal weakness or numbness. Physical examination shows ptosis of the right eye. Adduction and upward gaze are impaired on the right side. Pupils are 2 mm on the left and 5 mm on the right, and both are reactive to light Examination of other cranial nerves is unremarkable. Upper and lower extremity strength, deep tendon reflexes, and sensation are normal. Noncontrast CT scan of the head is normal.