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Multiple sclerosis — RACP Adult Medicine MCQ

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ModerateNeurologyMultiple sclerosisRACP Adult Medicine

A 28-year-old woman has 3 days of painful left visual loss. Two years earlier she had self-limited leg numbness for 2 weeks. Examination shows a left relative afferent pupillary defect and brisk reflexes in both legs. What is the most appropriate investigation?

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Correct answer: D — MRI brain and spine with gadolinium

Optic neuritis with a previous neurological episode suggests demyelination, and MRI assesses dissemination in time and space. CT is insensitive for demyelinating lesions. Carotid imaging and acetylcholine receptor antibodies target different diagnoses, and lumbar puncture is adjunctive rather than the first test here.

Reference: MS Australia consensus guidance; AMH