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Retired NBME Free 120 Answers
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j123
Fasciculations = UMN sign
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gabriellerenai
^ no fasciculations are a LMN sign, flaccid paralysis with twitching (fasciculations) is LMN lesion
FA 2019 pg 517
+3
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.
+1
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
+1
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submitted by โjbrito718(48)
This man likely has ALS-> weight loss, progressive weakness causing him to now be in wheelchair, dysphagia, no PMH, fasciculations. It is a mix of upper and lower motor neuron deficit and MOTOR ONLY. Because muscles will not be stimulated, they will atrophy. "USE IT OR LOSE IT"