<prompt> Acute onset areflexic quadriparesis with blurred vision and absent pupillary response in a 20 years old male, the most probable diagnosis is?PorphyriaBotulismPolioDiphtheria  <response>: ANSWER: B BotulismREF: Harrison s 17th ed p. 901, CMDT - 20061410The clinical picture is most consistent with diagnosis of botulismBotulismho recent injection of canned or smoked foods or injection of drugSymmetric descending paralysis with prominent bulbar palsyDiplopia , dysarthria , dysphonia , dysphagiaPupils are fixed and dilatedPtosis and cranial nerve palsy with impairment of extra ocular muscles and fixed dilated pupils are characteristic signsSensory examination is normalNormal sensoriumAfebrile 