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You are a Physician Associate working in the hospital. You are asked to examine a 60-year-old man who complains of stiffness and weakness upon climbing stairs. He has a history of HTN and well-controlled type 2 diabetes. On examination, there is upper limb weakness, the hip flexors are 4/5 in power, with bilateral wasting and fasciculations in the quadriceps. The knee extension is 4/5. However, the dorsiflexion and plantar flexion are 5/5. The ankle and knee reflexes are brisk and the positive Hoffman’s and Babinski’s signs are present. Sensory examination and the cranial nerves are unremarkable. His BM is 9, his pulse is regular and his BP is 160/95. What is the most likely diagnosis?
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