QuestionSBA
QuestionChoice
Symptoms of ALS and B12 deficiency are similar. Both cause progressive muscle weakness and loss of reflexes. However, ALS weakness and loss of tendon reflexes are usually asymmetric. In ALS, people may have speech and swallowing difficulties but the mind remains in tact as ALS does not affect upper motor neurons.
10000828
c
Amylotrophic lateral sclerosis (ALS)
QuestionChoice
Diabetic neuropathy is a similar presentation to B12 deficiency as they are both length-dependent neuropathies (i.e. longest neurons in the legs are affected first). However, diabetic neuropathy is more likely to happen in people who do not control their diabetes as well as this patient does (indicated by the stable HbA1c). Fine touch is the first sense to go in diabetic neuropathy.
10000827
b
Diabetic neuropathy
QuestionChoice
Sciatica is asymmetrical and only affects one side of the lower limb. However, like B12 deficiency, there are reduced reflexes. Sensory loss in sciatica has a "saddle distribution" around the perineal area.
10000830
e
Sciatica
QuestionChoice
Chronic metformin use can cause B12 deficiency. B12 deficiency will manifest with cognitive symptoms such as fatigue, brain fog, or depression. There may also be symmetrical muscle weakness that mainly affects the lower limbs, as well as loss of reflexes or pins and needles.
10000826
a
B12 deficiency
QuestionChoice
Symptoms of MS and B12 deficiency are similar. Both conditions can cause cognitive dysfunction, sensory disturbance, and progressive muscle weakness. However, B12 deficiency affects both sides of the body equally and is more pronounced in the legs. Also, MS may be more predominant on one side of the body than the other.
10000829
d
Multiple sclerosis (MS)
Concept
Chapter
2693
3831
Type 2 Diabetes
Topic
133
Endocrinology
12712
A 47-year-old female has a two-month history of worsening weakness in her legs, which is affecting her walking. She also reports feeling more tired and down than usual. She has a past medical history of well-controlled type 2 diabetes mellitus with metformin, which developed after giving birth 10 years ago. Her HbA1c has remained in the normal range over the years. On examination, there is mild sensory loss to the lower limbs and bilateral loss of ankle reflex.

What is the most likely cause of her weakness?
a