Step # 1

Emmerson is an active 55-year old male of Asian descent whoworks as a nurse. About six months ago, his wife commented that hewas dropping things and stumbling more commonly when he walked.Within the last few weeks, he has found it hard to work withpatients due to weakness in his arms and legs.

What system(s) of the body could Emmerson be experiencingproblems with and what diseases or disorders could be responsiblefor this?

Step # 2

A little more background on Emmerson. Up to this point in hislife, he has been active and relatively healthy.  Hiswork as a nurse keeps him active and in his spare time, he enjoysbicycle riding. He is 5'11\" and 205 pounds and is anon-smoker.   Recent medical issues include a brokenright radius as a result of a bicycle riding accident and theremoval of a basal cell carcinoma from his forehead.

As the symptoms progressed, Emmerson visited his health careprovider and the physician assistant he works with conducted thefollowing tests:

- heart rate and blood pressure normal
- temperature normal
- mental status check - normal
- arm / hand strength - less than expected
- CBC (Complete blood count which looks at the numbers of bloodcells) normal
- Blood chemistry panel - slightly elevated cholesterol, otherwisenormal
- Suspecting muscular or neurological issues, the PA ordered an MRIand CT of the brain which were normal.

What types of tests should be done next?

Step #3

You all did a nice job of speculating on the cause, but wecannot reach a diagnosis without further tests. As a result,Emmerson was sent to a neurologist for furthertesting.  

Electromyogram - normal
Nerve Conduction test - mostly normal
Advanced blood tests - normal
Bone density test - normal
Microscopic examination of muscle tissue (biopsy) - normal

These results were surprising, so the neurologist asked for amore thorough background on Emmerson. At that time, Emmersonremembered a family story about an uncle he never met who died inhis early 50's. When Emmerson called to relatives living in thePhilippines, they told him that they thought his uncle died fromAmyotrophic lateral sclerosis (ALS). What is ALS and could this bewhat Emmerson is experiencing?

**** I need help on step 3 I have answered step 1 and 2 alreadybut find myself stumped now! thank you!!!