MLA Domain 5 · Presentation

Limb weakness

5 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 1

Motor neurone disease

Respiratory compromise (FVC), bulbar dysfunction with aspiration; weight loss

recognised feature · 3

Conversion (functional neurological) disorder

Must exclude organic neurological disease; new "functional" symptoms in the elderly warrant caution

Lambert-Eaton myasthenic syndrome

Underlying small-cell lung cancer — investigate (CT chest, and re-screen if initially negative); respiratory/bulbar invo

Myasthenia gravis

Myasthenic CRISIS — respiratory muscle weakness (monitor FVC), bulbar weakness with aspiration; certain drugs trigger it

differential of the above · 1

Cervical spondylotic myelopathy

Rapid deterioration, bladder/bowel involvement, or significant cord signal change → urgent neurosurgical/spinal referral