ENTER

GREET THE EXAMINERS

SANITISE THE HANDS

INTRODUCE YOURSELF TO THE PATIENT

YOU WILL GET AN MG CASE IN THREE WAYS

A) EXAMINATION OF UPPER LIMBS

B) EXAMINATION OF LOWER LIMBS

C)EXAMINE THE PATIENT NEUROLOGICALLY APPROPRIATE

IF C IS THE COMMAND

THEN DO THE FOLLOWING

-ASK THE PATIENT 

-ASK PATIENT TO LOOK UP LOOKING AT YOUR FINGERS LOOK FOR EYES GETTING PTOSED & FATIGUABLE – IF POSITIVE THEN ITS AN MG

-ASK PATIENTS TO KEEP HANDS ON THE PILLOWS AND GIVE ARITHMETIC STRESS IF THERE ARE ASYMMETRICAL TREMORS THEN YOU ARE DEALING WITH PARKINSONS PATIENT

-ASK THE PATIENT TO CLOSE THE FIST AND RELEASE, IF YOU ARE FINDING SLOW GRIP RELEASE THEN YOU ARE DEALING WITH MYOTONIC DYSTROPHY 

IF IT IS AN MG CASE THEN

1)ESTABLISH OCCULAR FATIGUABILITY AS MENTIONED ABOVE

2)BULBAR FATIGUABILITY BY ASKING PATIENT TO COUNT UPTO 50, YOU CAN NOTICE A VOICE TURNING FATIGUABLE

3)PROXIMAL MUSCLE FATIGUABILITY 

-FIRST CHECK PROXIMAL MUSCLE STRENGTH

-THEN ASK THEM TO DO CHICKEN WINGING/BEATING

-THEN AGAIN CHECK

-IF IT IMPROVES WITH THE CHICKEN WINGING/BEATING TEST THEN YOU ARE DEALING WITH LEMS!!!

4)NEVER FORGET TO CHECK THE EYE MOVEMENTS BY LIFTING THE EYE LIDS UP. OPHTHALMOPLEGIA IS AN IMPORTANT COMPONENT TO BE ESTABLISHED.

WITH THIS YOU HAVE TO FINISH OTHER CN EXAMINATION IF THE COMMENT IS EITHER EXAMINE NEUROLOGICALLY APPROPRIATE OR EXAMINE THE PATIENTS’ CRANIAL NERVES. OR UPPER LIMB EXAMINATION IF THE COMMENT IS TO EXAMINE PATIENTS UPPER LIMB.