#march2020mccqe1
A 53-year-old woman is evaluated in the office for a 1-week history of paresthesias that began symmetrically in the feet and progressed to involve the distal legs and, more recently, the hands. She is unsteady when walking, has lower limb weakness, and has difficulty going upstairs. The patient has no history of pain or bowel or bladder impairment. Personal and family medical history is noncontributory, and she takes no medications. On physical examination, vital signs are normal. Weakness of distal lower extremity muscles is noted, with stocking-glove sensory loss and areflexia. Deep tendon reflexes are absent. Plantar responses are normal, and gait is unsteady. No sensory level is present across the thorax. Mental status, language, and cranial nerve function are normal. Complete blood count results, erythrocyte sedimentation rate, serum creatinine and creatine kinase levels, and liver chemistry test results are normal. A chest radiograph shows no abnormalities. Which of the following is the most likely diagnosis?
(A) Amyotrophic lateral sclerosis
(B) Diabetic neuropathy
(C) Guillain-Barre syndrome
(D) Myelopathy
A 53-year-old woman is evaluated in the office for a 1-week history of paresthesias that began symmetrically in the feet and progressed to involve the distal legs and, more recently, the hands. She is unsteady when walking, has lower limb weakness, and has difficulty going upstairs. The patient has no history of pain or bowel or bladder impairment. Personal and family medical history is noncontributory, and she takes no medications. On physical examination, vital signs are normal. Weakness of distal lower extremity muscles is noted, with stocking-glove sensory loss and areflexia. Deep tendon reflexes are absent. Plantar responses are normal, and gait is unsteady. No sensory level is present across the thorax. Mental status, language, and cranial nerve function are normal. Complete blood count results, erythrocyte sedimentation rate, serum creatinine and creatine kinase levels, and liver chemistry test results are normal. A chest radiograph shows no abnormalities. Which of the following is the most likely diagnosis?
(A) Amyotrophic lateral sclerosis
(B) Diabetic neuropathy
(C) Guillain-Barre syndrome
(D) Myelopathy
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