Multiple Sclerosis: The Daily PANCE Blueprint

Multiple Sclerosis: The Daily PANCE Blueprint

A 29-year-old woman presents with a week of severe vertigo, which she describes as continuous and unrelated to position changes. She has had difficulty walking and feels clumsy with hand movements. She recalls having transient neurologic symptoms over the past two years, including left-sided numbness and, more recently, pain in her right eye with blurry vision. These symptoms resolved after several weeks, and she never sought medical attention. On physical exam, she has horizontal strabismus, normal muscle strength, and diminished coordination in both hands. An MRI of the brain reveals multiple white matter lesions, confirming the diagnosis of multiple sclerosis (MS). What is the best short-term treatment for her current exacerbation?

A. Intravenous corticosteroids
B. Oral acyclovir
C. Azathioprine
D. IV glucose infusion
E. Plasma exchange therapy

Answer and topic summary

The answer is A. Intravenous corticosteroids

High-dose glucocorticoids are the first-line treatment for acute multiple sclerosis (MS) exacerbations. MS flares are characterized by new or worsening neurological symptoms that typically develop over days to weeks. In this case, the patient’s vertigo, walking difficulty, and hand incoordination suggest an acute relapse. Corticosteroids work by reducing inflammation and accelerating recovery from demyelination. Plasma exchange is reserved for cases that do not respond to steroids.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Neurology ⇒ Neuromuscular disorders ⇒ Multiple sclerosis

Also covered as part of the Internal Medicine EOR topic list

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