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free120/Block 3/Question#26 (reveal difficulty score)
A 45-year-old man is brought to the clinic by ...
Atrophy πŸ” / πŸ“Ί / 🌳

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submitted by βˆ—jbrito718(29),
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ihTs nam lleyik ahs &LA-gSt; thiewg slso, rispgrveeos kassneew snauicg mih ot onw be ni haewhcrlei, sighydap,a on HM,P icatslanfcusoi. tI si a xim fo euprp nad erolw omort nnouer teidcfi dan RTOOM YNL.O useaecB ssuemcl illw ont be md,iaetults they lliw ya.thrpo "USE IT OR LSOE TI"

submitted by βˆ—michik92(2),
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Cna enmoeos eesapl rfiacyl wyh isht ws'nta aaintyesmh sg?aivr

Teher w'enter nay purep tmroo euronn ssing in teh esquoitn s.etm

j123  Fasciculations = UMN sign +  
gabriellerenai  ^ no fasciculations are a LMN sign, flaccid paralysis with twitching (fasciculations) is LMN lesion FA 2019 pg 517 +  
gabriellerenai  but to answer the original question, MG usually presents with fluctuating (rather than progressive) weakness in extraocular and bulbar muscles before signs in limbs so it would be odd to not mention diplopia, dysphagia, trouble chewing etc. Additionally the fact that it is progressive leans toward ALS rather than fluctuating (MG). Also if you were still between ALS and MG, MG = middle aged woman while ALS is a middle aged man. +  
gabriellerenai  ooooo my bad dysphagia is mentioned but the progressive feature, enough to put him into a wheelchair still stands out to me as ALS, and dysphagia and aspiration are often what leads to death in ALS +  

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