Multiple Sclerosis

Context and Definition

Pathophysiology

Characteristic Symptoms of MS

Epidemiology and Causes of MS

Clinical Assessment

6 Topics

Classic Symptoms and Their Classes

Optic Neuritis: General

Optic Neuritis: Phenomena

Other Presentations Associated With MS

Differential Diagnoses

3 Topics

Multiple Sclerosis

Multiple Sclerosis

Multiple Sclerosis Multiple Sclerosis

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Question 1 of 10

1. Question
In a patient known to have mild symptoms of MS, who presents to the emergency department (ED), with a clinical picture of community-acquired pneumonia with a CURB65 score of 1, which of the following is correct?
- Normalising a low grade pyrexia with antipyretics may prolong the infection
- Antibiotic therapy should be directed against a broader spectrum of organisms
- The patient will require HDU to monitor their respiratory function
- Oral antibiotics are indicated
Question 2 of 10

2. Question
Which of the following descriptions regarding MS is most correct?
- It is an axonal disease of the of the central nervous system (CNS)
- It is a demyelinating disorder of the brain and spinal cord
- It is a combination of optic neuritis and CNS demyelination
- It typically presents with symptoms relating to two or more lesions
- It is associated with other auto-immune diseases
Question 3 of 10

3. Question
Classic symptoms of MS include all the following except:
- Cramps due to muscle spasticity
- Dysarthria, ataxia and tremor
- Paresthesia as a late symptom
- Bladder, bowel and sexual dysfunction
- Depression
Question 4 of 10

4. Question
In a patient presenting to the ED with optic neuritis, which of the following is correct?
- Optic neuritis is the presenting feature of MS in 30-50% of patients who are subsequently diagnosed with the disease
- Recurrent isolated episodes of optic neuritis tend to favour a diagnosis of MS.
- The ocular pain is usually unaffected by eye movements
- Whilst the decreased visual acuity usually settles over days the ocular pain persists for several months
- The patient may have an afferent pupil defect (Marcus Gunn pupil) on examination
Question 5 of 10

5. Question
Complete the following statement. The diagnosis of MS
- Is made on the basis of MRI findings
- Is made on the basis of MRI and lumbar puncture findings
- Is dependent upon the opinion of a neurologist
- Can be made in the ED in patients with typical features
- Requires evidence of lesions distinct in site or time
Question 6 of 10

6. Question
In a severely-ill MS patient, who presents to the ED with a clinical picture of community-acquired pneumonia, which of the following is correct?
- Interferon should be administered to prevent further deterioration of the MS and respiratory function
- Corticosteroids may exacerbate the infection and are contra indicated
- Endotracheal intubation has the same risk of aspiration of gastric contents as non-MS patients
- MS patients are at higher risk of hypotension at induction of anaesthesia
Question 7 of 10

7. Question
Regarding the prognosis of MS, which of the following is correct?
- MS is usually associated with a normal life expectancy
- Most MS patients do not die as a result of their MS
- Patients with MS are usually wheel chair bound within 15 years of diagnosis
- Cognitive changes and intellectual decline occur in up to 30% of MS patients
- Sensory symptoms at onset are associated with a better prognosis
Question 8 of 10

8. Question
Regarding the prognosis for MS, which of the following is incorrect?
- MS is the commonest non-traumatic cause of disability in young adults
- Generally, sensory and cranial nerve symptoms predict a more favourable outcome than those associated with motor nerve or cerebellar dysfunction
- In patients with severe secondary progressive MS, the suicide rate is twice the population average for the same age group
- Acute fulminant MS is a rare aggressive rapidly deteriorating form of MS that leads to death or severe residual disability within days
Question 9 of 10

9. Question
A 40-year-old woman has been diagnosed with MS with a relapsing-remitting pattern of disease over 7 years. Regarding options for long-term medical therapy, which one of the following statements is correct?
- Cyclosporin is effective in reducing the relapse rate
- Azathioprine increases 5 year survival by 30-40%
- β–interferon reduces relapse rate by up to 30%
- Cannabinoids are prescribed to reduce muscle spasticity
- Linoleic acid diet supplementation is recommended to reduce relapse rate
Question 10 of 10

10. Question
Regarding the possible pitfalls in the management of MS, which of the following statements is correct?
- Although MS typically presents in the 20-50-year age group, presentation in patients over 55 years is not uncommon
- The diagnosis of MS can be made with confidence in patients with recurrent optic neuritis
- The only disease modifying drugs licensed for MS require IV administration
- Quality of life can be improved by attending to known precipitants and complications

7 Comments

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Ahmad Alabood June 12, 2019 at 9:53 pm

Good session

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cunnanel5709 July 4, 2019 at 12:21 pm

Comprehensive review

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Rachael Prince July 5, 2019 at 1:01 pm

Thank you, I learned a lot on this module

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Yasser Emam July 21, 2019 at 1:21 pm

Great

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Mr. Salman Ahmed Abbasi September 2, 2021 at 5:48 am

very nice explanation and advise from management in ED

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Dr Kashif Hussain December 23, 2021 at 1:33 pm

very important case and can present in ED. Be ready for unexpected cases in the Emergency Department.

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Dr Syed Shahbaz Ahmer May 24, 2024 at 11:49 am

Good revision

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