<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 isPorphyriaBotulismPolioDiphtheria  <response>: Answer is B Botulism: Sudden onset of blurred vision, absent pupillary reflexes fixed dilated pupil with lack of accomodation, symmetric descending paralysis progressing to qudriparesis and preserved sensorium suggest a diagnosis of Botulism. Cardinal Feature of Botulism Cranial Nerve Palsies with prominent bulbar palsy 4 Ds of Bulbar Palsy Diplopia, Dysahria, Dysphonia, Dysphagia, Ptosis, Loss of Accomodation, Fixed Dilated pupils Descending motor paralysis Extent of paralysis from a few cranial nerves only to quadriperesis depends on dose of toxin Symmetry of symptomssigns A clear sensorium Absence of fever Lack of sensory findings 