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NMJ Problems (e.g. Myasthenia Gravis) – Exam presentation

How to present a patient with a neuromuscular junction problem for doctors, medical student exams, OSCES, PACES and USMLE


  • I examined Mrs McDonald’s upper limbs
  • On general inspection I noted bilateral ptosis and a handheld spirometer beside her bed
  • On examination I noted normal tone but decreased power, more prominent in the proximal muscle groups. I noted that the power in her shoulders was initially 4/5 but then decreased to 3/5 after sustained elevation
  • There was definite fatigability in the muscle groups, which I tested by asking Mrs Jones to hold her arms above her head for as long as possible
  • Reflexes were present bilaterally and sensation was normal
  • In summary, the main physical sign elicited in this examination was that of muscle fatigability which would be consistent with a neuromuscular junction disorder such as myasthenia gravis


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Perfect revision for medical student finals, OSCES and PACES