A 48-year-old woman presents with 3 months of fluctuating double vision, drooping eyelids (ptosis), and difficulty chewing, which are worse at the end of the day. Her symptoms improve after rest. Physical exam reveals fatigable weakness of extraocular muscles. Which of the following is the most appropriate initial pharmacological treatment?
✓ Correct Answer: Option B
The patient's symptoms of fluctuating, fatigable muscle weakness, particularly ptosis and diplopia, worsening with activity and improving with rest, are classic for myasthenia gravis. Pyridostigmine, an acetylcholinesterase inhibitor, is the initial symptomatic treatment to improve muscle strength.