Prolonged upward gaze test
Have the patient gaze upward at examiner's finger for 30 seconds
Diplopia or ptosis that develops is suggestive of<unk> 
Ice Pack Test - should improve symptoms temporarily (usually ptosis; high specificity)
Place ice-pack on eyes for 2 mins, if ptosis decreases by ≥2mm the test is positive
Acetylcholine receptor antibodies (AcHR-Ab). Positive in 80-90% of generalized<unk>  and 40-55% in Ocular<unk> .
Have the patient gaze upward at examiner's finger for 30 seconds
Diplopia or ptosis that develops is suggestive of<unk> 
Place ice-pack on eyes for 2 mins, if ptosis decreases by ≥2mm the test is positive
Flaccid paralysis resulting from cholinergic crisis can be distinguished from<unk>  by the use of the drug edrophonium, which worsens the paralysis caused by cholinergic crisis, but strengthens the muscle in the case of<unk> . (Edrophonium is an cholinesterase inhibitor hence increases the concentration of acetylcholine present).<unk>  Crisis
Respiratory failure is feared complication
Much more common
Due to medication non-adherence, infection, surgery, tapering of immunosuppressants, meds
Cholinergic Crisis
Excessive anticholinesterase medication may cause weakness and cholinergic symptoms
Rarely if ever seen with dose limitation of pyridostigmine to less than 120mg q3hr
If on usual dose of meds assume exacerbation due to<unk>  even with cholinergic side effects
Edrophonium (Tensilon) test to distinguish the two is controversial
Give 1-2mg IV slow push. If any fasciculations, respiratory depression, or cholinergic symptoms within a few minutes, problem is likely cholinergic crisis (no more edrophonium). If no evidence of cholinergic excess, give total of 10mg and observe improvement in case of<unk>  crisis.
Side effects of Edrophonium: Arrhythmias, Hypotension, Bronchospasm
Thus, need to be on a monitor, with atropine on hand
Treatment: Atropine
Respiratory failure is feared complication
Much more common
Due to medication non-adherence, infection, surgery, tapering of immunosuppressants, meds
Excessive anticholinesterase medication may cause weakness and cholinergic symptoms
Rarely if ever seen with dose limitation of pyridostigmine to less than 120mg q3hr
If on usual dose of meds assume exacerbation due to<unk>  even with cholinergic side effects
Give 1-2mg IV slow push. If any fasciculations, respiratory depression, or cholinergic symptoms within a few minutes, problem is likely cholinergic crisis (no more edrophonium). If no evidence of cholinergic excess, give total of 10mg and observe improvement in case of<unk>  crisis.
Side effects of Edrophonium: Arrhythmias, Hypotension, Bronchospasm
Thus, need to be on a monitor, with atropine on hand
Treatment: Atropine
Myasthenia gravis
Antibiotics 
Polymyositis
Steroids
Lambert-Eaton myasthenic syndrome
Anticonvulsants 
Tick paralysis
Psychotropics 