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Multiple Sclerosis

Context and Definition

Pathophysiology

Characteristic Symptoms of MS

Epidemiology and Causes of MS

Clinical Assessment

Classic Symptoms and Their Classes

Optic Neuritis: General

Optic Neuritis: Phenomena

Other Presentations Associated With MS

Differential Diagnoses

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
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Antibiotic therapy should be directed against a broader spectrum of organisms
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The patient will require HDU to monitor their respiratory function
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Oral antibiotics are indicated
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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)
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It is a demyelinating disorder of the brain and spinal cord
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It is a combination of optic neuritis and CNS demyelination
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It typically presents with symptoms relating to two or more lesions
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It is associated with other auto-immune diseases
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Question 3 of 10

3. Question

Classic symptoms of MS include all the following except:

Cramps due to muscle spasticity
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Dysarthria, ataxia and tremor
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Paresthesia as a late symptom
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Bladder, bowel and sexual dysfunction
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Depression
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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
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Recurrent isolated episodes of optic neuritis tend to favour a diagnosis of MS.
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The ocular pain is usually unaffected by eye movements
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Whilst the decreased visual acuity usually settles over days the ocular pain persists for several months
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The patient may have an afferent pupil defect (Marcus Gunn pupil) on examination
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Question 5 of 10

5. Question

Complete the following statement. The diagnosis of MS

Is made on the basis of MRI findings
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Is made on the basis of MRI and lumbar puncture findings
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Is dependent upon the opinion of a neurologist
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Can be made in the ED in patients with typical features
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Requires evidence of lesions distinct in site or time
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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
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Corticosteroids may exacerbate the infection and are contra indicated
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Endotracheal intubation has the same risk of aspiration of gastric contents as non-MS patients
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MS patients are at higher risk of hypotension at induction of anaesthesia
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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
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Most MS patients do not die as a result of their MS
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Patients with MS are usually wheel chair bound within 15 years of diagnosis
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Cognitive changes and intellectual decline occur in up to 30% of MS patients
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Sensory symptoms at onset are associated with a better prognosis
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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
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Generally, sensory and cranial nerve symptoms predict a more favourable outcome than those associated with motor nerve or cerebellar dysfunction
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In patients with severe secondary progressive MS, the suicide rate is twice the population average for the same age group
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Acute fulminant MS is a rare aggressive rapidly deteriorating form of MS that leads to death or severe residual disability within days
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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
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Azathioprine increases 5 year survival by 30-40%
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β–interferon reduces relapse rate by up to 30%
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Cannabinoids are prescribed to reduce muscle spasticity
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Linoleic acid diet supplementation is recommended to reduce relapse rate
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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
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The diagnosis of MS can be made with confidence in patients with recurrent optic neuritis
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The only disease modifying drugs licensed for MS require IV administration
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Quality of life can be improved by attending to known precipitants and complications
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9 Comments

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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Mr Michael Davey November 14, 2024 at 9:45 pm

very good teaching. I knew very little about MS and this has helped a lot

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Dr Ajaz Amin Qasba January 7, 2026 at 11:16 pm

thanks

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