Question (EMQ) of the day – a history of weakness and fatigue


A 64 year old man presents with a history of weakness and fatigue. He has lost 3 stone in weight. On systemic enquiry, he has no other clinical symptoms, other than a mild dry cough which he has had for 3 days and some occasional dysuria, present intermittently for 6 months. His examination findings are as follows:

  • No Jaundice , anaemia, cyanosis, jaundice or lymphadenopathy
  • noted rash under both eyelids.
  • BP 134/66
  • Pulse 78 regular
  • Sats 98% air
  • BM 4.5 mmol/l  RR 16
  • Normal Cardiovascular Respiratory Gastrointestinal examination.

Neurology as follows:

  • Grade 4 power upper and lower limbs symmetrically.
  • Normal sensory examination.
  • Normal reflexes.
  • No clonus
  • No fatigability

Where is the likely pathology?

Central Brain Lesion
Brainstem Lesion
Cord Lesion
Peripheral Nerve
Neuromuscular Junction
Acetylcholimesterase enzyme problem
Muscle lesion
None of the above

Let us know what you think, answer to follow soon. Remember: more questions like these can be found in the free trial area.

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