Miller Fisher syndrome — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsMiller Fisher syndromeSCE Acute Medicine

A 29-year-old woman presents with acute neurological symptoms. Relevant history includes vascular, infectious or neuromuscular risk factors. On assessment, neurological examination shows focal or global dysfunction. Investigations show ophthalmoplegia, ataxia, areflexia and anti-GQ1b positivity. What is the most likely diagnosis?

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Correct answer: C — Miller Fisher syndrome

The key discriminator is that ophthalmoplegia, ataxia, areflexia and anti-GQ1b positivity, which makes Miller Fisher syndrome the single best answer. Anaphylaxis is less appropriate because it does not address the dominant acute risk in the vignette; Septic shock would fit a different presentation or later stage of care. Toxic drug ingestion and Pulmonary embolism are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-97-1