You are asked to see a 59-year-old otherwise healthy man in consultation for weakness and falls....

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You are asked to see a 59-year-old otherwise healthy man in consultation for weakness and falls. He first noticed clumsiness and difficulty with performing tasks such as writing about 6 months ago, and the symptoms seem to be getting worse. He has had 3 falls, one of them resulting in a scalp laceration that required sutures. He denies visual symptoms. His speech and swallowing are normal, and his bowel and bladder function are intact. He denies any pain in his muscles. On physical examination, he has mild muscle atrophy in the quadriceps and biceps. He has increased tone. Reflexes are 3+ in the upper and lower extremities distally. Toes are up- going. Strength is 4 to 4+ throughout the upper and lower extremities. Fasciculations are noted. Heel- and toe-walking are impaired. After the patient completes the diagnostic tests, his wife contacts you to discuss the case. She is worried that her husband is not emotionally resilient and would not cope well with bad news. He is undergoing a lot of stress at work; his wife feels that any bad news would be devastating to him and may affect his ability to succeed. She asks to meet with you privately to review the results of the tests so that she can decide when and how to disclose the information to her husband. 3a. Based on the available information, what is the MOST LIKELY diagnosis? (total marks, 1) 3b. List TWO elements that should be considered when addressing the wife's request. (total marks, 2) You are asked to see a 59-year-old otherwise healthy man in consultation for weakness and falls. He first noticed clumsiness and difficulty with performing tasks such as writing about 6 months ago, and the symptoms seem to be getting worse. He has had 3 falls, one of them resulting in a scalp laceration that required sutures. He denies visual symptoms. His speech and swallowing are normal, and his bowel and bladder function are intact. He denies any pain in his muscles. On physical examination, he has mild muscle atrophy in the quadriceps and biceps. He has increased tone. Reflexes are 3+ in the upper and lower extremities distally. Toes are up- going. Strength is 4 to 4+ throughout the upper and lower extremities. Fasciculations are noted. Heel- and toe-walking are impaired. After the patient completes the diagnostic tests, his wife contacts you to discuss the case. She is worried that her husband is not emotionally resilient and would not cope well with bad news. He is undergoing a lot of stress at work; his wife feels that any bad news would be devastating to him and may affect his ability to succeed. She asks to meet with you privately to review the results of the tests so that she can decide when and how to disclose the information to her husband. 3a. Based on the available information, what is the MOST LIKELY diagnosis? (total marks, 1) 3b. List TWO elements that should be considered when addressing the wife's request. (total marks, 2)

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