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Multiple sclerosis relapse — MCCQE Part 1 MCQ

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ModerateNumbness/TinglingMultiple sclerosis relapseMCCQE Part 1

29-year-old woman presents with subacute unilateral visual loss and pain on eye movement. MRI shows demyelinating lesions separated in space. Which of the following is the most appropriate next step?

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Correct answer: D — Treat significant optic neuritis relapse with high-dose corticosteroids and refer to neurology

Treat significant optic neuritis relapse with high-dose corticosteroids and refer to neurology is best because optic neuritis with typical MRI lesions suggests MS relapse. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Disease-modifying therapy decisions require specialist counselling.

Reference: Canadian MS Working Group recommendations