Physical examination for Myasthenia gravis

Introduction: MG is a neuromuscular autoimmune disease that attacks the nicotinic receptors. Increases muscle fatigue. less than 50, more common in women and associated with thymic dysplasia and autoimmune conditions. greather than 50 more common in men and associated and associated with thymic atrophy or tumor.

Presentation: extraocular, bulbar(swallowing, chewing), face, neck limb girdle, trunk are affected in that order.

1. Inspection: look for ptosis, squints, myasthenia snarl on smiling.
2. Test eye movements: ask for diplopia, test upward gaze for 30s to look for ptosis or failure to upward gaze.
3. Test proximal muscle strength: neck flexion, arm abd/add, hip flexion.
4. Test reflexes:normal
5. Test speech: gradual hypophonia, nasal escape as control of soft palate is lost.