A 68 year old homeless man is admitted to the hospital.

Question Number 0808

A 68 year old homeless man is admitted to the hospital. He complains of lightning like pains in his legs and belly. He walks with a dramatic marked sway and is visibly uncoordinated. It is very difficult for the intern to get any sort of medical history from him, so he summons the resident. On physical examination, the intern notices that there is a sensory deficit affecting both of his legs. He does not have the ability to detect vibratory sensation. When his big toe is moved, the man guesses the correct orientation about half the time. The intern asks him to stand with his feet together. He comments to the chief resident that 'he does not sway'. The chief resident then asks him to close his eyes, and comments to the intern, 'he sways'. Neither intern nor resident is able to elicit Achilles or patellar reflex. His strength and muscle tone are adequate. What condition should be included in the differential diagnosis?

a) Friedreich's ataxia
b) tabes dorsalis
c) amyotrophic lateral sclerosis
d) cerebellar ataxia
e) polio


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