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

Myaesthenia Gravis Stem: Please examine this person's eyes. Key Features 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 Proximal arm weakness with fatiguability Look for thymectomy scar Ask for spirometry / RFTs Presentation 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. Back to Index Back to Example Cases Back to Neurology