In myasthenia gravis, symptoms worsen with which factors?

• A. Exercise and infection
• B. Rest and sleep
• C. Adequate nutrition
• D. Adequate hydration

Answer: (A)

In myasthenia gravis, weakness is fatigable and worsens with use of the muscles. This happens because antibodies reduce the number of functional acetylcholine receptors at the neuromuscular junction, so repeated or sustained stimulation leads to progressively weaker contractions as transmission becomes harder to achieve. When you exercise or repeatedly use a muscle, acetylcholine release and receptor availability can’t keep up, causing the strength to dip with continued activity. Infections add another layer of stress to the body and immune system, further impairing transmission and increasing fatigue, so weakness worsens during illness. Rest and sleep help restore some neuromuscular transmission between uses, and good nutrition and hydration support overall health but don’t specifically drive the fatigable pattern. Therefore, symptoms worsen with exercise and infection.