Approach to weakness (focal and generalized) Quiz: Ace Your Exams
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A 37-year-old man presents to the emergency department for evaluation of bilateral leg weakness for one day. The patient’s legs feel heavy, and there has been increasing difficulty walking, including tripping on stairs. For the past few hours, he has also had shortness of breath. There is no significant medical history, and no daily medications are used. Immunizations are up to date, including the annual influenza vaccine, which was administered three weeks ago. Temperature is 37.0°C (98.6°F), pulse is 84/min, respirations are 14/min, blood pressure is 135/85 mmHg, and oxygen saturation is 96% on room air. On exam, there is symmetric bilateral weakness with ankle dorsiflexion, knee flexion and extension, and a loss of vibration sense. Deep tendon reflexes are absent in both lower extremities. Which of the following tests is most appropriate to obtain?
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