| December 7, 2015

Annie felt despondent. Her teammates were being kind to her, but she knew that she was the reason that her team
lost the swim meet against the neighboring college. How many people could lose with a four-second lead on the
anchor leg of a 50-yard relay against someone they had beaten so easily last year? As she walked out of the locker
room she noticed that the blurred vision and eye strain had returned, even though she was wearing glasses instead
of her usual contacts. Her eye strain had become worse over the past month. Over the last week she had had midterm exams and papers to write and recently typing made her hands and fingers ache and they felt weak. Even
swim practice, which helped relieve her stress in the past, had become taxing. Her coach noticed that her times
were getting worse, even though he could see that she was working hard in practice.Annie�s boyfriend Matt was waiting for her as she walked out of the locker room. He attended another college and had made a detour to drive her home for mid-term break.

�Thanks for driving all this way to take me home, Matt. I�m sorry that you made it early enough for the meet; I
was really bad. I just don�t know what�s wrong with me these days.�

Matt didn�t know what to say, so he smiled and took her hand. As they walked back to her dorm, Annie was
gasping for air and felt weaker than ever after they had walked up the two flights of stairs to her floor. She told
herself that she must set some time aside next week to do something about this constant fatigue. Annie had already packed her bags for the trip home and Matt was able to carry all of her stuff to his car in one trip. When he
returned to the room he found Annie lying on the bed with her eyes closed. He asked her if she was ready to go.
�Sure, just can�t keep my eyes open these days. I am sure I�ll be better when we�re home.�

Matt knew that Annie liked to drive, so when they got to the car he handed her the keys. She tried to take them, but
her fingers didn�t seem to work and she dropped his keys on the ground. Matt grabbed the keys and opened the
passenger door for Annie. As they set off for home, Matt asked, �Are you feeling okay? You�re not usually so
exhausted after a swim meet, and you seem to be having trouble catching your breath. I am worried about you.�
�I have been feeling really tired over the past month or so, and I guess mid-terms took more out of me than usual.�

1. What signs or symptoms does Annie exhibit and can you see a common theme in Annie�s signs and symptoms?

2. What muscles are responsible for breathing and why is Annie having problems breathing?

3. In addition to the muscular disorder Myasthenia Gravis, what are other possible reasons for Annie�s condition?

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