92306 wrote:
D) MRI of the head
best initial and accurate test for MS
yes, this is the best way to say it!
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| Aashi
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Classic s/s of MS----->Do an MRI------>D
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| doc_clotaire
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The correct answer is D.
This patient complains of a variety of symptoms, but they are localizing. She complains of paresthesias and dysesthesias in her right hand, this in
association with increased deep tendon reflexes of her upper extremities. She also has
pain behind her left eye in association with partial atrophy of her left optic nerve. This
patient has classic symptoms of multiple sclerosis and with inflammation of the orbital
portion of the optic nerve, usually unilateral. Weakness is a very important symptom in
MS, and is particularly important when it occurs in only one area of the body (localized
or focal weakness). MRI is the diagnostic modality of choice to ascertain the presence of
the characteristic demyelinating lesions.
CSF fluid analysis (choice A) may reveal elevated protein levels but this finding is
neither sensitive nor specific.
Electromyography (choice B) will determine where along the motor neuronneuromuscular
conduit the cause for the weakness lies. Specifically it will determine if
the weakness is due to intrinsic muscle weakness. Since this is not a diagnostic test, it is
not superior to an MRI in this setting.
This patient has clear physical findings that are consistent with some sort of organic
disturbance. The MMPI (choice C) is reserved for people in whom a primary psychiatric
disorder is suspected (conversion or somatoform disorder). It provides clear, valid
descriptions of people’s problems, symptoms, and characteristics in broadly accepted
clinical language.
Serum protein electrophoresis or SPEP (choice D) is useful for diagnosing
immunoglobulin deficiency or excess (macroglobulinemias).
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