To tell _____ truth, it is ______ struggle for Jack to get ready in such a short time.  [ ]

A. the; real a

B. a; a real

C. the; really a

D. a, a really

男性，28岁。清晨起床时发现四肢无力，近端尤甚，且逐渐加重。体检：四肢近端肌力Ⅱ度，远端Ⅳ度，肌张力低下，腱反射消失。急查血清K⁺3.2mmol/L。

该患者最可能伴发的疾病为（）.

A.甲状腺功能亢进

B.心肌病

C.慢性肝炎

D.红斑狼疮

E.皮肌炎