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Multiple sclerosis — USMLE Step 2 CK MCQ

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ModerateInternal MedicineMultiple sclerosisUSMLE Step 2 CK

A 51-year-old Asian American man comes to the clinic because of progressive symptoms. History and focused examination are notable for optic neuritis, internuclear ophthalmoplegia, and periventricular plaques. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate initial diagnostic study?

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Correct answer: D — MRI brain and spine with gadolinium

The vignette describes Multiple sclerosis, supported by optic neuritis, internuclear ophthalmoplegia, and periventricular plaques. MRI brain and spine with gadolinium is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: https://www.ncbi.nlm.nih.gov/books/#stage-9-order-26