Royal Australasian College of Physicians Examinations/Resources/Clinical Exam/Short Cases/Example Cases/Myaesthenia Gravis
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Myaesthenia Gravis[edit | edit source]
Stem: Please examine this person's eyes.
Key Features[edit | edit source]
- 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 | edit source]
- Proximal arm weakness with fatiguability
- Look for thymectomy scar
- Ask for spirometry / RFTs
Presentation[edit | edit source]
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.