EMQs in Clinical Medicine.pdf - Peshawar Medical College

Weakness in the legs 77
31 Weakness in the legs
A
B
C
D
E
F
myasthenia gravis
Charcot–Marie–Tooth disease
polymyalgia rheumatica
motor neuron disease
Guillain–Barré syndrome
syringomyelia
G
H
I
J
K
L
alcohol-induced neuropathy
Parkinson’s disease
polymyositis
multiple sclerosis
bilateral stroke
neurofibromatosis
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
1 A 60-year-old woman complains of bilateral proximal muscle weakness in the
legs and dysphagia. On examination she has a purple rash on her cheeks.
2 A 40-year-old man presents with a recent history of progressive weakness in the
arms and legs after an episode of diarrhoea. Examination revealed flaccid weakness
of limbs with no reflexes.
3 A 55-year-old man presents with bilateral progressive worsening muscle weakness.
There is marked wasting of lower limb muscles and very brisk lower limb
reflexes. Sensation is normal.
4 A 13-year-old boy presents with bilateral pes cavus with clawing of the toes.
There is atrophy of peroneal muscles and reduced reflexes and sensation distally.
5 A 30-year-old secretary presents with bilateral leg weakness and blurred vision.
Fundoscopy reveals pale optic discs bilaterally.
Answers: see page 92.