Royal Australasian College of Physicians Examinations/Resources/Clinical Exam/Short Cases/Example Cases/Myaesthenia Gravis

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Myaesthenia Gravis[edit]

Stem: Please examine this person's eyes.

Key Features[edit]

  • Ptosis – may be asymmetrical. Worse after sustained upward gaze
  • Diplopia (+/- ophthalmoplegia) with sustained upward gaze
  • Bulbar weakness -> dysarthria (counting back from 20 to 1)
  • Neck extensor weakness

Proceed to[edit]

  • Proximal arm weakness with fatiguability
  • Look for thymectomy scar
  • Ask for spirometry / RFTs


Presentation[edit]

This patient has clinical features of myaesthenia gravis; evidenced by bilateral ptosis and diplopia on upward gaze; weakness of neck extension and fatiguability of shoulder abductors with a median sternotomy scar that suggests a previous thymectomy.

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