NBME 24 Answers : Block 4 : #27 = A 19-year-old man has had weakness of the muscles ...

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NBME 24 Answers

nbme24/Block 4/Question#27

A 19-year-old man has had weakness of the muscles ...

Polyneuropathy

+10 upvote downvote
submitted by lsmarshall(262),

Polyneuropathy - A condition involves damage to multiple peripheral nerve fibers. Patients typically present with symmetric distal sensory loss or a burning sensation associated with motor weakness. Classic polyneuropathy is burning so this question was more process of elimination. Others did not fit well.

+5 upvote downvote
submitted by ameanolacid(13),

Couldn't be ALS b/c he had sensory involvement...ALS is distinctly only motor. Not Syringomyelia (which is upper extremities sensory then motor later on) bc I assumed by the wording that all 4 extremities were involved. Obv not Parkinsons, and not polio bc again, he has motor + sensory.

sympathetikey Probably in part due to early age presentation, but I hear you +2

wowo FA2019 p518 - process of elim for other spinal cord lesions +

+2 upvote downvote
submitted by majic(3),

"Poly- meaning many/multiple + nueropathy. Nueropathies in multiple locations that results in weakness, impaired position or burning pain. The most common cause of polyneuropathy is a Vitamin B6 deficiency. The most common genetic cause is Charcot-Marie-Tooth The most common infectious cause is Guillain-Barré

+1 upvote downvote
submitted by medstruggle(10),

Can someone please explain this? What is the diagnosis here?

welpdedelp I thought it just as it was, polyneuropathy is supposed to be a burning pain affecting the extremities, he might have acute intermittent porphyria. He was too young and didn't fit ALS due to the rapid onset. No loss of pain in the arms so it couldn't be syringomelia. Wasn't asymmetric so couldn't be polio. Didn't have anything resembling Parkinson. +5

+1 upvote downvote
submitted by nutcraker(3),

Looks like Tabes dorsalis polyneuropathy to me, 19 y/o with loss of propioception, parasthesias...