MG

Question 1

What are the common examination findings?

Answer 1

• Ptosis or abnormal eye movements - Ask patient to look up for a long time
• Dysarthria - count to 30

MYASHTENIA - THINK THYMOMA

• Proximal muscle weakness - ask to hold hands above head
• NB - Thymoma scar

Inspection - above

Tone/Reflexes/ Sensation/Coordination all normal

Question 2

What are the investigations?

Answer 2

• To finish the exam i would like to do - Upper/lower limb exam and cranial nerves
• By the bed - History, obs
• Bloods - ACH receptor antibodies, AI tests so TFT, Glucose, FBC for anaemia
• Other - Mediastinal imaging for thymoma

Question 3

What are the key investigation findings?

Answer 3

ACH receptor postive

Thymoma

Any other positive AI association

Question 4

What is the treatment?

Answer 4

• Conservative - Education - eg be aware of resp failire, refer to MG society
• Medical - ACH esterase inhibitors eg pyridostigmine
• Surgical - Thymoma removal

Question 5

What are other causes for bilateral ptosis?

What is it?

Answer 5

Congenital

Bilateral horners

Myotonic dystrophy

Autoimmune where body attacks the muscle receptors causing fatigueable weakness