QuestionSBA
QuestionChoice
Diagnosis of multiple sclerosis requires the presence of white matter lesions disseminated in space and time. This requires the use of imaging, and an MRI has the highest sensitivity and positive predictive value. Although the presence of oligoclonal bands can be diagnostically useful, non-invasive investigations should be performed first.
10000338
c
Lumbar puncture and CSF analysis
QuestionChoice
The most important diagnosis to rule out here is multiple sclerosis (MS). This patient has presented with optic neuritis and has previously experienced spontaneously remitting neurological abnormalities. A diagnosis of multiple sclerosis requires white matter lesions disseminated in space and time. The history has revealed symptoms disseminated in time. An MRI of the brain and spinal cord has the highest sensitivity for demyelinating white matter lesions disseminated in space and is therefore the best diagnostic investigation.
10000336
a
MRI Brain and Spinal Cord
QuestionChoice
The most likely diagnosis in this patient is MS. This patient has presented with optic neuritis, which is a common first MS presentation and is characterized by reduced visual acuity and pain which is worse on eye movement. Ocular tonometry has no place in the diagnosis of MS and is much more likely to be used in the diagnosis of glaucoma.
10000340
e
Ocular tonometry
QuestionChoice
Although evoked potential studies can be useful in the diagnosis of MS, the BMJ state they should typically be performed in patients for whom an MRI is contraindicated, which is not the case here. Evoked potential studies in a patient with MS typically demonstrate prolonged conduction.
10000339
d
Evoked potential studies
QuestionChoice
The most likely diagnosis here is MS. Although imaging is required to confirm this diagnosis, CT scans have low positive predictive value for multiple sclerosis and are therefore much less suitable than an MRI.
10000337
b
CT Head
Concept
Chapter
2693
3745
Multiple Sclerosis
Topic
141
Neurology
12614
A 31-year-old female presents to the outpatient neurology clinic with a 10-day history of vision loss in her left eye. She says that the eye is painful whenever she moves it. Upon taking her history, she reveals that 3 months ago she experienced a sensation of pins and needles in both legs that lasted 2 weeks and resolved spontaneously. Examination reveals no focal neurological abnormality but visual acuity in the left eye is reduced.

Which of the following is the best diagnostic investigation?
a