Review Question - QID 102946

Action	Numeric Key	Letter Key	Function Key
Choose 1	1
Choose 2	2
Choose 3	3
Choose 4	4
Choose 5	5
Submit Response			Enter
Previous Question			Left Arrow
Next Question		N	Right Arrow
Open/Close Bookmode		C
Open Image			Spacebar

Multiple Sclerosis QID: 102946 (M3.NE.16.5)

QID 102946 (Type "102946" in App Search)

A 55-year-old caucasian man presents to his primary care physician with a complaint of double vision, which started suddenly with no precipitating trauma. Twelve years ago, he presented to his physician with painful vision loss, which has since resolved. Since that initial episode, he had numerous episodes early-on in his disease course: two additional episodes of painful vision loss, as well as three episodes of right arm weakness and three episodes of urinary retention requiring catheterization. All of his prior episodes responded to supportive therapy and steroids. Which of the following features of this patient's disease is linked to a more benign disease course?

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Age at onset

21%

4/19

Race

11%

2/19

Initial presenting symptoms

16%

3/19

Gender

21%

4/19

Number of episodes early in the disease

26%

5/19

Select Answer to see Preferred Response

Review TC In New Tab

This patient has multiple sclerosis (MS). Initial presentation with optic neuritis or sensory symptoms are good prognostic indicators for patients with MS.

Multiple sclerosis is a demyelinating condition involving multiple neurologic deficits separated in space and time. The etiology of the disease is unknown, although it is believed to have an autoimmune component. Patients with MS have a number of different disease courses including: relapsing-remitting, primarily or secondarily progressive, or relapsing progressive (Illustration A). Relapsing-remitting MS is thought to be the most benign and is associated with female gender, age of onset < 40, and optic neuritis or sensory symptoms as the first presenting symptoms.

Calabresi discusses the diagnosis and management of MS. MS is characterized by demyelination and axonal degeneration. Common presenting symptoms include numbness, weakness, visual impairment, depression, and fatigue. Diagnosis is based on objective findings of two or more neurologic signs localized to the brain or spinal cord, disseminated in space and time.

Swanton et al. discuss the prognosis of multiple sclerosis. Features that have historically denoted a more benign course include: female gender, clinical onset before age 40, few early relapses, slow early accumulation of fixed deficits, and initial involvement of only sensory symptoms. Despite this knowledge, prognosis information is still limited and requires further study.

Illustration A demonstrates the different disease courses of patients with MS.

Incorrect Answers:
Answer 1: An age less than 40 at presentation is linked to good prognosis, but this patient was 43 when he first had symptoms.
Answer 2: Race is not associated with the prognosis of MS.
Answer 4: Female gender, not male, is associated with a good prognosis.
Answer 5: Fewer episodes early in the disease process is linked to a good prognosis, not many episodes.

ILLUSTRATIONS: