A 50 year old farmer is admitted with a history of bilateral leg weakness that has been progressively ascending for the past week. He reports a bout of diarrhoea around 2-3 weeks ago. Given the likely diagnosis what additional feature is least likely?

A 48 year old man presents with a 6 month history of progressive weakness affecting his arms and legs. More recently he has started to notice his speech is slurred. On examination he has weakness throughout upper and lower limbs with muscle wasting and dysarthria. Which would be the most useful investigation to aid in making a diagnosis?

63F presents with a two week history of progressive weakness and dysphagia. There is no diurnal variation. On examination she has a violaceous rash over the eyelids and papules over the knuckles. Tone is normal. Shoulder abduction is 1/5 bilaterally and finger extension 4/5. Hip flexion is 1/5 bilaterally and foot dorsiflexion and plantarflexion is 4/5. Given the likely diagnosis, what is the pattern of weakness and where would you localise the lesion to?

63F presents with a two week history of progressive weakness and dysphagia. There is no diurnal variation. On examination she has a violaceous rash over the eyelids and papules over the knuckles. Tone is normal. There is a proximal pattern of weakness bilaterally. Reflexes are normal. Which of the following investigations would give you a definitive diagnosis?

63F presents with a two week history of progressive weakness and dysphagia. There is no diurnal variation. On examination she has a violaceous rash over the eyelids and papules over the knuckles. Tone is normal. There is a proximal pattern of weakness bilaterally. Reflexes are normal. A muscle biopsy has been sent off, with your working diagnosis of dermatomyositis. What additional investigation should you consider at this stage?

A 35 year old woman presents with a band-like sensation around her abdomen, leg weakness and bladder dysfunction. On questioning she reveals that she had an episode around a year ago, where she experienced left eye pain and problems with her vision, this resolved within a few weeks and she did not seek medical attention. On examination she has increased tone in her legs, bilateral weakness and hyperreflexia. Where would you localise the lesion?

A 35 year old woman presents with a band-like sensation around her abdomen, leg weakness and bladder dysfunction. On questioning she reveals that she had an episode around a year ago, where she experienced left eye pain and problems with her vision, this resolved within a few weeks and she did not seek medical attention. On examination she has increased tone in her legs, bilateral weakness and hyperreflexia. What is the most important investigation to confirm the likely diagnosis?

A 35 year old woman presents with a band-like sensation around her abdomen, leg weakness and bladder dysfunction. On questioning she reveals that she had an episode around a year ago, where she experienced left eye pain and problems with her vision, this resolved within a few weeks and she did not seek medical attention. On examination she has increased tone in her legs, bilateral weakness and hyperreflexia. What is/are the key factor(s) required to make a diagnosis of multiple sclerosis?

A 75-year-old right handed lady presents having woken at 7am with new onset speech disturbance and right-sided weakness. She was last seen well before going to bed at 10pm the night before. She has a past medical history of hypertension and hypothyroidism. You complete an ABCDE assessment and an ECG shows an irregularly irregular rhythm at a rate of 75bpm. On examination, right upper and lower limb power is 3/5 and she is unable to name objects. The rest of the examination is unremarkable. What is the likely diagnosis?

A 75-year-old right handed lady presents having woken at 7am with new onset speech disturbance and right-sided weakness. She was last seen well before going to bed at 10pm the night before. She has a past medical history of hypertension and hypothyroidism. You complete an ABCDE assessment and an ECG shows an irregularly irregular rhythm at a rate of 75bpm. On examination, right upper and lower limb power is 3/5 and she is unable to name objects. The rest of the examination is unremarkable. Following your assessment, which initial investigation should be carried out?

A 75-year-old right handed lady presents having woken at 7am with new onset speech disturbance and right-sided weakness. She was last seen well before going to bed at 10pm the night before. She has a past medical history of hypertension and hypothyroidism. You complete an ABCDE assessment and an ECG shows an irregularly irregular rhythm at a rate of 75bpm. On examination, right upper and lower limb power is 3/5 and she is unable to name objects. The CT brain is reported as NAD however the patient’s symptoms are ongoing. Which of the following treatments should be commenced?

A 68-year-old man presented with a 3-day history of progressively weak legs, and is now unable to walk. There is no numbness or tingling, no speech or swallowing problems, no visual change and no weakness of the arms. He does not recall any symptoms like this before. He says he is usually fit and well, however has chronic back pain and has had problems with urinary dysfunction for which he has been taking tamsulosin. He also thinks he has lost weight. He is a lifelong smoker. What would be most important to do initially after a neurological examination?

A 68-year-old man presented with a 3-day history of progressively weak legs, and is now unable to walk. There is no numbness or tingling, no speech or swallowing problems, no visual change and no weakness of the arms. He does not recall any symptoms like this before. He says he is usually fit and well, however has chronic back pain and has had problems with urinary dysfunction for which he has been taking tamsulosin. He also thinks he has lost weight. He is a lifelong smoker. What is the most likely underlying diagnosis?

A 68-year-old man presented with a 3-day history of progressively weak legs, and is now unable to walk. There is no numbness or tingling, no speech or swallowing problems, no visual change and no weakness of the arms. He does not recall any symptoms like this before. He says he is usually fit and well, however has chronic back pain and has had problems with urinary dysfunction for which he has been taking tamsulosin. He also thinks he has lost weight. He is a lifelong smoker. Which investigation would be most useful in establishing the diagnosis?

A 60 year old man, presented with a 3 month history of progressive left leg weakness. He has type 2 diabetes mellitus but is otherwise fit and well. On examination of the lower limbs: inspection is normal, tone normal, left leg power is grade 1/5 and right leg power 5/5. On examination of the reflexes the left leg reflexes are slightly brisker than the right. On sensory examination there is reduced sensation to the coldness of the tuning fork and pin prick in the right leg. Where is the lesion?

A 60 year old man, presented with a 3 month history of progressive left leg weakness. He has type 2 diabetes mellitus but is otherwise fit and well. On examination of the lower limbs: inspection is normal, tone normal, left leg power is grade 1/5 and right leg power 5/5. On examination of the reflexes the left leg reflexes are slightly brisker than the right. On sensory examination there is reduced sensation to the coldness of the tuning fork and pin prick in the right leg. Which of these would be the most likely diagnosis?