All right, welcome. My name is Devine. This is episode 435 of the Devine Intervention

Podcasts and into these podcasts I'm going to be addressing diseases of the

neuromuscular junction. Diseases of the neuromuscular Junction.

This should be a short podcast, but it should be a podcast that's pretty high yield for your exam.

Let's just get right into it.

So what if they give you a question about a lady in her 30s and they tell you that she comes to the physician because she has been having trouble keeping her eye open at work and

detailed that on physical exam she has like a dropy eyelid and you're told that when you

tell her when you do the hitch in space test multiple times

it gets harder and harder for her to keep our eye open. In fact they may tell you that as you do the

hitch and space test more and more and more

the degree of droopiness gets worse and they also tell you that all this person

has you know like proximal muscle weakness and they tell you that this person

has no deficits of light touch, pinprick vibratory sensation and they also tell you that this person's reflexes are completely normal.

Reflexes are normal and they can even tell you that when the person is told to walk in a straight line,

they're able to walk normally without a taxi. If you see something like this, what should you be thinking about?

I really hope you're saying, oh divine, this person has my stenographis. The thing is some distractors they can try to trip you up with on your exam.

They can put something like polio dramatomyocytes as an answer.

Just because of that one thing I said about proximal

muscle weakness and then they can also just put a bunch of other things like

lupus some rheumatology thing like rheumatoid arthritis don't fall for those things.

I can put the whole clinical picture together in arriving at a diagnosis.

So this person has my stenographis. Remember in people that have my stenographis, essentially they have anti-acetocoline

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