<prompt> Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is -PorphyriaBotulismPolioDiphtheria  <response>: Ans. is tb i.e., Botulism Remember these important points about Botulismo Acute onset of weakness in muscles innervated by cranial nerve with prominent bulbar palsy 4Ds i.e. - Diplopia Dysphonia Dysphagia Dysarthriao Descending symmetrical weakness occurs often leading to weakness,o Sensory abnormalities are absent because only motor and autonomic nerves affected.o Mental function not affected o Afebrileo Absent pupillaty reflexes 