Question of the day: Neurological exam

A 44 year old builder presents with weakness over the past 48 hours

A neurological exam reveals the following (N=normal):

Upper Limbs

Lower Limbs

Right

Left

Right

Left

Tone

N

reduced

N

N

Power (MRC)

4/5

4/5

3/5

4/5

Coordination

N

N

N

N

Sensation

Fine touch

Proprioception

N

N

N

N

N

N

N

N

Reflexes

Biceps

triceps

supinator

– (absent)

– (absent)

+

– (absent)

– (absent)

+ with reinforcement

Knee

Ankle

Plantar

– (absent)

– (absent)

down

– (absent)

– (absent)

down

Which of the following is the most likely diagnosis?

a. Polio
b. Motor Neurone disease
c. Myasthenia gravis
d. Stroke
e. Multiple sclerosis
f. Creutzfeldt Jacob disease
g. Guillain Barre Syndrome

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