Problem:
A 4-month-old female is new patient who presents with her mother for a routine exam. She was born in Honduras via vaginal delivery, full term, but breech presentation in her home. Birth weight is unknown, but mother reports was about normal. Her mother reports that she has always been a fussy baby, especially during feeding since she tends to stick her tongue out and gag on formula. Physical exam reveals a head circumference over 95th percentile, with height and weight less than 5th percentile. The infant has poor head control and floppy upper body tone, but she arches her back repeatedly and her lower limbs appear stiff and rigid with spasticity. The baby does not appear to alert to sound and has nystagmus. Her facial features are somewhat coarse in appearance with a low brow. The rest of her exam was unremarkable. The clinical picture associated with these findings is most consistent with: Group of answer choices a. a mucopolysaccharidoses. b. Charcot-Marie Tooth disease. c. Guillain Barre syndrome. d. Juvenile myasthenia gravis. e. an adrenoleukodystrophy. f. tuberous sclerosis