question: Q:A 57-year-old woman is brought to the emergency department by her husband with complaints of sudden-onset slurring for the past hour. She is also having difficulty holding things with her right hand. She denies fever, head trauma, diplopia, vertigo, walking difficulties, nausea, and vomiting. Past medical history is significant for type 2 diabetes mellitus, hypertension, and hypercholesterolemia for which she takes a baby aspirin, metformin, ramipril, and simvastatin. She has a 23-pack-year cigarette smoking history. Her blood pressure is 148/96 mm Hg, the heart rate is 84/min, and the temperature is 37.1°C (98.8°F). On physical examination, extraocular movements are intact. The patient is dysarthric, but her higher mental functions are intact. There is a right-sided facial weakness with preserved forehead wrinkling. Her gag reflex is weak. Muscle strength is mildly reduced in the right hand. She has difficulty performing skilled movements with her right hand, especially writing, and has difficulty touching far objects with her index finger. She is able to walk without difficulty. Pinprick and proprioception sensation is intact. A head CT scan is within normal limits. What is the most likely diagnosis?? 
  {'A': 'Dysarthria-clumsy hand syndrome', 'B': 'Lateral medullary syndrome', 'C': 'Locked in syndrome', 'D': 'Parinaud’s syndrome', 'E': 'Pure motor syndrome'},