Approach to differentiating lesions (muscle) Quiz: Ace Your Exams

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A 60-year-old man presents to the neurology clinic for evaluation of weakness. For the past several years, he has noticed gradually progressive, persistent weakness of both hands, leading to difficulty opening jars, dressing, and writing. These symptoms do not change throughout the day. His past medical history includes hypertension, for which he takes lisinopril. There is no family history of similar symptoms. The patient’s temperature is 37.0°C (98.6°F), pulse is 72/min, respirations are 14/min, and blood pressure is 128/85 mmHg. On physical exam, he is alert and has normal facial muscle strength. No abnormal skin lesions are present. Bilateral muscle weakness is noted, particularly in finger flexion, knee extension, and dorsiflexion of the feet. Atrophy of the quadriceps is also observed. Sensation is intact throughout. Which of the following additional diagnostic tests can help confirm the diagnosis?

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Muscle biopsy

Deletion/duplication analysis of the DMD gene

Serum potassium level

Repeat expansion analysis of the DMPK gene

Sequencing of the CACNA1S or SCN4A genes