Quiz Answers with Rationale

Which of the following is true regarding multiple sclerosis (MS).

  1. MS is a disease involving the peripheral nervous system affecting the axons of lower extremities first.
  2. MS is a chronic inflammatory disease, caused by an autoimmune response, resulting in degeneration of myelin sheath in the CNS.
  3. MS is a disorder of the CNS caused by the Varicella-zoster virus.
  4. Exacerbation of MS causes damage to the cell body (soma) of sensory neurons.

Rationale: MS is a chronic inflammatory, demyelinating disease of the CNS. The pathogenesis of MS is autoimmune. Exacerbation of MS causes damage to the myelin sheath of the nerve axon. While MS is thought to be caused by an infection, the etiology is unknown. MS affects the axons located in the white and gray matter of the CNS.

You are treating a patient experiencing an exacerbation of MS. Which lab value would you expect to find?

  1. Elevated CSF immunoglobulin G (IgG)
  2. Elevated Vitamin D levels
  3. Critically low hemoglobin and hematocrit
  4. Positive hepatitis B surface antigen screen

Rationale: IgG autoantibodies play a role in the inflammatory process of MS and are likely to be found elevated in the CSF. Vitamin D levels are expected to decrease, as low Vitamin D levels are suspected to aid in contributing to an acute exacerbation.

A patient newly diagnosed with MS has arrived at your clinic. Which of the following is most likely to be true regarding this patient?

  1. The patient is a 45-year-old male with a positive family history of MS.
  2. The patient is female and recently had a bacterial infection not treated with antibiotics.
  3. The patient is a 30-year-old female presenting with relapsing remitting episodes of recurrent neurological symptoms.
  4. The patient is male IV drug user presenting with flu-like symptoms.

Rationale: The onset of MS is most common between the ages of 20 and 40 years old. Female to male ratio is about 2:1. The patient may have had a recent infection. Genetic components and environmental factors could also have a role in an MS diagnosis. Neurological symptoms that occur at least twice, for over 24 hours each time and a month apart are common in the presentation of MS. The patient most likely to present with a diagnosis of MS in this scenario is the 30-year-old female presenting with relapsing remitting episodes of neurological symptoms.

What is the best treatment for a patient experiencing an acute MS exacerbation?

  1. Corticosteroids, such as methylprednisolone, to promote a swift recovery.
  2. Penicillin, an antibiotic, to treat the infection.
  3. Vitamin D supplement to promote a positive progression.
  4. Oseltamivir, an antiviral, to prevent viral replication.

Rationale: While an exacerbation of MS may occur at the same time as an infection, MS itself cannot be treated with antibiotics. Antibiotics should only be given in the presence of a bacterial infection. Vitamin D supplements should be given consistently in a patient with MS due to the likelihood of low vitamin D levels. Antivirals are only appropriate in patients with a viral infection. A Corticosteroid is the best treatment option to decrease the inflammation and prevent further nerve damage from the immune system.

You suspect your patient is experiencing symptoms of MS. The patient has never been diagnosed with MS, you have taken a thorough history and have ruled out other diagnoses. The last 3 months your patient has had 2 separate episodes of asthenia (atypical muscle weakness) along with brainstem symptoms lasting more than 24 hours. What is your next step to confirm diagnosis?

  1. Order a brain MRI to assess for plaques and tangles.
  2. Obtain serum ammonia levels, a head CT to rule out hemorrhage, and admit the patient to the hospital for further testing.
  3. Diagnosis can be confirmed from the provided information.
  4. Order a brain MRI to assess for demyelinating plaques and obtain a CSF sample to measure the IgG index.

Rationale: MS is diagnosed after other diagnoses with similar symptoms are ruled out. To confirm diagnosis the practitioner will the consider the patient’s signs and symptoms with a detailed, thorough history, obtained a brain MRI that shows areas suggestive of demyelinating plaques as well as obtain a sample of CSF to measure the IgG index, which is likely to be elevated.

A patient diagnosed with Spinal MS will present with which of the following symptoms?

  1. Memory problems and vision changes.
  2. Ataxia and weakness in extremities.
  3. Rapid onset of severe headache and tachycardia.
  4. Bladder and bowel problems.

Rationale: Spinal MS symptoms commonly present as weakness, numbness, bladder and bowel problems. Memory problems and vision changes are more likely to occur with Opticospinal MS. Ataxia and weakness in extremities are common symptoms of Cerebellar MS. Rapid onset of a severe headache and tachycardia are symptoms not directly related to MS.