Medicine – MCQ 117 – 18-year-old male with acute onset descending paralysis of 3 days duration

An 18-year-old male presented with acute onset descending paralysis of 3 days duration. There is also a history of blurring of vision for the same duration. On examination, the patient has
quadriparesis with areflexia. Both the pupils are non reactive. The most probable diagnosis is:
a) Poliomyelitis
b) Botulism
c) Diphtheria
d) Porphyria

Correct answer : b) Botulism

The important features of the patient are descending paralysis, blurring of vision and non reactive pupils. Descending paralysis is caused by 3 of the conditions mentioned – polio, botulism, and diphtheria. Diphtheria and botulism can cause ocular symptoms. But only botulism will result in a non reactive pupil. Hence the diagnosis of botulism!