Introduction

Wash your hands, introduce yourself, and ask permission (consent) to examine. Ask if the patient has any pain before you begin.

Inspection

Look for:

- Ptosis (drooping eyelids)
- Thymectomy scars (thymus malignancies are associated with myasthenia gravis)
- 'Snarling' facies

Eyes

Look for:

• Movements (may have opthalmoplegia) & diplopia
• Fatiguability - test sustained upgaze
• Fatiguability - test repeated blinking

Speech

Listen for:

• Nasal sounding speech(bulbar-like palsy)
• Get the patient to count upwards - may slow down/change character of speech as they fatigue

Arms

Test:

• Make 'chicken wing' type movements (to demonstrate fatiguability)
• Always exercise your judgement in terms of 'over-straining' the patient. If they are starting to get tired then bear this in mind and modify your examination accordingly. Always thank them when you finish.