<prompt> 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 -PoliomyelitisBotulismDiptheriaPorphyria  <response>: Botulism is caused by neurotoxins of Clostridium botulinum, which are extremely potent cause disease after ingestion of even picogram amounts. Its classical form is an acute onset of bilateral cranial neuropathies associated with symmetric descending weakness.The toxin causes predominantly bulbar ocular palsiesdifficulty in swallowing ,blurred or double vision ,ptosis,progressive to limb weakness respiratory paralysis . Reference Harrison20th edition pg 1027 