![]() Test speech (count to 50) ?fatiguability.Ask to do ‘chicken wing arm exercises 10-20 times’ then retest power (weaker after exercise). Test power of elbow flexion/extension, shoulder abduction.Neck flexion and extension against resistance.Test eye closure (peek sign) and test lip closure.Quick neuro assessment: tone, power, sensation (sensation is normal in myasthenia and myotonic dystrophy), reflexes (reduced/absent in myotonic dystrophy), coordination.Temporal arteries palpation (if age >50).Make a point of testing CN 4 (ask to look down and in) and CN 6 (ask to look laterally) Eye movements and ask if gets double vision (observe for opthalmoplegia) and fatiguability on looking up for 20 seconds (myasthenia).Inspect: ptosis (uni/bilateral, symmetrical/asymmetrical, partial/complete),eye position, pupils (size: big in CN III palsy, small in Horners, normal in myasthenia/myotonic dystrophy/CN III palsy).PMH: autoimmune conditions, CVS risk factors.Consider Horner’s syndrome: cough, haemoptysis, chest pain, smoking history, weight loss (Pancoasts tumour causing Horner’s syndrome), loss of sweating on face/arms/trunk, any trauma/surgery on neck, any pain in neck, any headache.Neuro Questions: sensory loss, headache, seizures, tremor, unsteadiness, etc.Consider Myotonic dystrophy: balding, cataracts, heart problems, lung problems, gut problems, diabetes, excessive daytime sleepiness.Triggers of myaesthenic crisis: infection, drugs (recent antibiotics, beta-blockers, calcium channel blockers.Double vision: is this worse at the end of the day.Timing questions: symptoms since when, sudden/gradual onset, intermittent/constant symptoms, getting worse, worse at the end of the day?. ![]() In station 5 you may be asked to assess a patient with eyelid drooping, double vision, weakness etc.
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