The Daily PANCE PANRE Question 69

A 58 year-old male presents complaining of weakness of his grip. Your examination reveals that the problem is bilateral. During the next few office visits, you note the development of hyperactivity of his DTRs, extensor plantar reflexes and dysarthria. The patient's sensory system remains normal and he denies any urinary symptomatology. Which of the following is the most likely diagnosis? A. multiple sclerosis B. Alzheimer's disease C. Huntington's chorea D. amyotrophic lateral sclerosis E. myasthenia gravis Answer:D, amyotrophic lateral sclerosis ALS (Lou Gehrig's disease) is a progressive bilateral muscle disease which causes fasciculations (lower motor neuron), and hyper-reflexia, plantar reflexes (upper motor neuron) and dysarthria. Sensation is normal as is bladder function. MS may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affected. Alzheimer's has normal neuro exam with cognitive disability. Huntington's causes a movement disorder with writhing choreiform movements of the body. Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day. Help Support The Physician Assistant Life for FREE! This is provided as an opportunity for anyone who appreciates this email series to help support it painlessly. If you are going to be purchasing anything from Amazon.com (books, school supplies, etc.) simply start your next Amazon.com purchase byclicking here... it's a free way for you to help support the cause! Justclick over to Amazon. Then, when you make your purchase, Amazon will send a portion of the proceeds to The Physician Assistant Life. The money goes toward paying for one-time and ongoing costs (like equipment, hosting, backup services, etc.). Thank you for supporting the site and keeping this content free! If you are studying for the PANCE or the PANRE I recommend theseReview Books. The Daily PANCE PANRE Question 69 A 58 year-old male presents complaining of weakness of his grip. Your examination reveals that the problem is bilateral. During the next few office visits, you note the development of hyperactivity of his DTRs, extensor plantar reflexes and dysarthria. The patient's sensory system remains normal and he denies any urinary symptomatology. Which of the following is the most likely diagnosis? A. multiple sclerosis B. Alzheimer's disease C. Huntington's chorea D. amyotrophic lateral sclerosis E. myasthenia gravis Answer:D, amyotrophic lateral sclerosis ALS (Lou Gehrig's disease) is a progressive bilateral muscle disease which causes fasciculations (lower motor neuron), and hyper-reflexia, plantar reflexes (upper motor neuron) and dysarthria. Sensation is normal as is bladder function. MS may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affected. Alzheimer's has normal neuro exam with cognitive disability. Huntington's causes a movement disorder with writhing choreiform movements of the body. Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day. Help Support The Physician Assistant Life for FREE! This is provided as an opportunity for anyone who appreciates this email series to help support it painlessly. If you are going to be purchasing anything from Amazon.com (books, school supplies, etc.) simply start your next Amazon.com purchase byclicking here... it's a free way for you to help support the cause! Justclick over to Amazon. Then, when you make your purchase, Amazon will send a portion of the proceeds to The Physician Assistant Life. The money goes toward paying for one-time and ongoing costs (like equipment, hosting, backup services, etc.). Thank you for supporting the site and keeping this content free! If you are studying for the PANCE or the PANRE I recommend theseReview Books.