A 40-year-old male with diabetes presents with a complaint of low back pain that is d

Discussion in 'Plab 1 and 2 forum' started by Santosh Jadhav, Oct 25, 2013.

  1. Santosh Jadhav

    Santosh Jadhav Active Member

    A 40-year-old male with diabetes presents with a complaint of low back pain that is dull in nature, which started 2 days ago. This morning he woke up
    with a feeling of numbness in his feet, which gradually seemed to worsen. By noon, he noted difficulty walking and decided to come to the ED. He denies bowel or bladder incontinence. On exam, he is in no acute distress and has a respiratory rate of 12. He has strength 5/5 in his upper extremities, and in his lower extremities strength is 4/5 proximally and 3/5 distally. Sensory examination reveals a mild decrease in pinprick and light touch in a stocking distribution to the mid-calf. Reflexes in the upper extremities are 2 + /4 and in the lower extremities are trace at the knees and absent at the Achilles. Plantar response is down going bilaterally.

    What is the most likely diagnosis?
    A) Diabetic polyneuropathy.
    B) Guillain-Barré syndrome.
    C) Diabetic amyotrophy.
    D) Stroke.

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