Myasthenia Gravis (MG) examination

Myasthenia Gravis (MG) examinationCreated OnJune 2, 2020Last Updated OnJune 2, 2020byadmin You are here: Main Clinical Examination Myasthenia Gravis (MG) examination < All Topics Table of Contents Physical examination: General Inspection: Build of the patient Look for signs of respiratory distress, going into failure? (Emergency) Bedside: Look for spirometer Hand: Pallor of palm (Pernicious anemia) Any Raynaud’s Phenomenon (Scleroderma) Any joint deformity/destruction/tenderness, Boutonniere deformity of thumb, Swan neck deformity (Rheumatoid Arthritis) Look for fine tremor (Hyperthyroidism) Pulse rate Tachycardia (Hyperthyroidism) Check blood pressure Hypertension (Hyperthyroidism) Hypotension (Addison’s Disease) Face: Malar flush (SLE) Eye: Observe for any ptosis Any exophthalmos (Hyperthyroidism) Red eye/ Dry eye (Sjogren’s Syndrome) Pale conjunctiva (Pernicious Anemia) Mouth: Dry mouth, tooth decay (Sjogren’s Syndrome) Oral ulcers (SLE) Neck: Notice any head drop Thyroid examination for any thyroid swelling (Grave’s disease) Expose the chest to look for scar: Median sternotomy scar – Typical incision for thymoma removal. Skin: Discoid rash (SLE) Calcinosis (Scleroderma) Joints: Arthritis Motor Tone: Normal Power: Test power before and after provocative maneuver (listed below). There will be decreased in power after the maneuver. More prominent in the proximal muscle groups. Deep tendon reflex: Normal *Hallmark – Muscle weakness in MG becomes progressively worse during periods of physical activity and improves after periods of rest. Provocative maneuver Eye: Ask patient to sustain up gaze (30-60 seconds) – Upright gaze test Observe for ptosis, usually bilateral but asymmetrical) Complex ophthalmoplegia (Medial rectus) leading to diplopia Look for Peek sign – Ask patient to close eyes tightly, with sustained closure, orbicularis oculi will be fatigue results sclera of the eye become apparent under the partially open eye. Sustain lateral gaze (60 seconds) – can results in diplopia Bulbar: Ask patient to count out loud from 1 – 20. Listen for voice deterioration. Listen for nasal speech (Dysarthria) Ask patient to open mouth, depress the tongue with a tongue depressor and ask patient to say “AH”. MG weakness can result in inability to elevate the soft palate. MG can lead to weakness of laryngeal muscles causing hoarseness of voice. Can be resulted by asking patient to make a high pitched (-eeee-) sound. Respiratory: Ask patient to count 1-20 aloud, patient can result in dyspnea. This can give an idea of patient’s vital capacity. (Multiply the number that patient achieve with one breath by 100) – estimated vital capacity. Limbs: It will show proximal muscle weakness. Upper Limb Test power for shoulder abduction Then ask patient to repeat shoulder abduction for 20 times Repeat testing power for shoulder abduction – Strength will reduce Lower Limb Test power for hip flexion Then ask patient to squat 20 times Then assess power again There will be decreased in power after the maneuver Sensory Normal Investigation: Tensilon test: Intravenous injection of short acting anticholinestrase. First 2mg is injected initially, followed by 8mg 30 seconds later if there are no side effect. Improvement in muscle function occurs within 30 seconds and usually persists for 2-3minutes. Electromyography (EMG) studies: Show a characteristic decremental response if muscles affected Auto-antibodies Anti-acetylcholine...

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