Multiple Sclerosis

Chapter 46 Multiple Sclerosis




Clinical Case Problem 1 A 27-Year-Old Woman with Weakness, Visual Loss, Ataxia, and Sensory Loss


A 27-year-old woman comes to your office for assessment of symptoms including weakness, visual loss, bladder incontinence, sharp shooting pain in the lower back, clumsiness when walking, and sensory loss. These symptoms have occurred during three episodes (different combinations of symptoms each time) approximately 3   months apart, and each episode lasted approximately 3   days.


The first episode consisted of weakness, bladder incontinence, and sharp shooting pains in the lower back (in both hip girdles). The second episode consisted of visual loss, clumsiness when walking, and sensory loss. The third episode (last week) consisted of sharp shooting pains in the lower back and sensory loss (bilateral) in the upper extremities.



Select the best answer to the following questions




1. Given this information, what is the most likely diagnosis in this patient?


a. amyotrophic lateral sclerosis

b. multiple sclerosis (MS)

c. vitamin B12 deficiency

d. hysterical conversion reaction

e. tertiary syphilis




2. There are four clinical categories of this disease. Which of the following subtypes does the patient presented fit into?


a. relapsing-remitting

b. secondary progressive

c. primary progressive

d. progressive relapsing

e. none of the above

3. If you had the opportunity to do only one diagnostic test, which of the following would you choose?


a. computed tomography scan of the head and spinal cord

b. magnetic resonance imaging (MRI) scan of the brain and spinal cord

c. serum vitamin B12 levels

d. Beck depression scale

e. Venereal Disease Research Laboratory test for syphilis

4. The disease is most correctly described as which of the following?


a. an uncommon neurologic disease that can be corrected by the administration of subcutaneous vitamin B12

b. the number one cause of disabling disease of young adults in the United States

c. a common psychiatric condition in which psychological symptoms are manifested by physical symptoms

d. a fatal neurologic condition that results in continual deterioration to the point of respiratory depression and the cessation of respiration

e. none of the above

5. The disease described is associated with which of the following?


a. racial predilection: whites more often than African Americans

b. sex predilection: females more often than males

c. high socioeconomic status

d. environmental exposure

e. all of the above

6. Which of the following statements regarding the behavior of the disease described is (are) true?


a. in 80% to 90% of all cases, the first episode is followed by a cycle of relapses and remissions

b. 50% of those with relapsing-remitting cases switch to a progressive course approximately 5   years after the onset of the first symptoms

c. 10% of patients have progressive disease from the onset of symptoms

d. up to 10% of patients with this disease have a relatively “benign” course

e. all of the above

7. The disease, if diagnosed as a central nervous system (CNS) disease, has to involve how many different areas of the central nervous system?


a. one

b. two

c. three

d. four

e. not applicable: not primarily a neurologic disease

8. Which of the following clinical findings support(s) the diagnosis?


a. a cerebrospinal fluid (CSF) mononuclear cell pleocytosis

b. an increase in CSF immunoglobulin G (IgG)

c. oligoclonal banding of CSF IgG (two or more bands)

d. abnormalities in evoked response testing (any type)

e. all of the above

9. The target of this disease process is an attack on which of the following?


a. the neurotransmitter balance in the CNS

b. the oligodendrocytes of the CNS

c. the peripheral nerves in the posterior columns of the spinal cord

d. the cerebral hemispheres

e. the cerebellum

10. What is (are) the treatment(s) of choice for the disease process described?


a. adrenocorticotropic hormone (ACTH)

b. corticosteroids

c. mitoxantrone (Novantrone)

d. interferon beta

e. natalizumab (Tysabri)

f. all of the above

11. Which of the following statements regarding the use of interferon in this disorder is (are) true?


a. interferon has been shown to reduce the rate of relapse

b. interferon may delay the progression to disability

c. interferon reduces the development of new lesions as seen by MRI

d. interferon delays the increase in volume of lesions as seen by MRI

e. all of the above

12. Which of the following symptoms is the least common?


a. optic neuritis

b. ataxia

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Multiple Sclerosis

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