Wash your hands, introduce yourself, and ask permission (consent) to examine. Ask if the patient has any pain before you begin.
- Ptosis (drooping eyelids) - Thymectomy scars (thymus malignancies are associated with myasthenia gravis) - ?Snarling? facies
- Movements (may have opthalmoplegia) & diplopia - Fatiguability ? test sustained upgaze - Fatiguability - test repeated blinking
- Nasal sounding speech(bulbar-like palsy) - Get the patient to count upwards - may slow down/change character of speech as they fatigue
- Make ?chicken wings? 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.
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