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



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