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.

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