This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Miscellaneous, Subject name: Medicine
What is the most likely diagnosis in this patient who was having difficulty swallowing? 
Select and explain. 
A. Amyloidosis, B. Amyotrophic lateral sclerosis, C. Pellagra, D. Pernicious anemia
B: Amyotrophic lateral sclerosis
Answer: B: Amyotrophic lateral sclerosis 
Explanation: Answer B. Amyotrophic lateral sclerosisWith his difficulty swallowing, the patient's tongue atrophy represents a bulbar symptom, and is most consistent with a diagnosis of amyotrophic lateral sclerosis (ALS). The patient also had clinical and neurophysiological evidence of upper-motor-neuron and lower-motor-neuron involvement, which supported the diagnosis. ALS is associated with dysarthria, hypophonia, dysphagia, and sialorrhea in addition to relentlessly progressive disability.