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Medicine
A 45-year-old man presents with weakness and fasciculations in his arms and legs. His cranial nerves are normal, but there is weakness of his left handgrip and right leg quadriceps with loss of muscle bulk. There are obvious fasciculations over the left forearm and right thigh. Tone is increased in the arms and legs and the reflexes are brisk. Which of the following is the most likely diagnosis?
amyotrophic lateral sclerosis (ALS)
myotonic muscular dystrophy
amyotonia congenita
tabes dorsalis
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