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

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Myaesthenia Gravis

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Stem: Please examine this person's eyes.

Key Features

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  • 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

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


Presentation

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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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