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Which is the most predictive factor of the progression of MS disease and subsequent disability?

Choose the statement below that provides correct patient education regarding multiple sclerosis:

You are in the ED and have been called to assist in the evaluation of an elderly patient who fell earlier today. The CT shows a concave, crescent-shaped mass between the skull and the surface of the cerebral hemisphere. The mass has crossed the sagittal suture line posteriorly. Which of the following is most likely diagnosis?

A 50-year-old male presented to the emergency department with a headache and nausea. His wife said that he wasn’t acting himself and as the day went by, he became more and more lethargic. In the ED he was able to answer simple questions. He was admitted to the hospital and his confusion worsened. He had a seizure the morning following admission and was transferred to the ICU. CSF analysis:Lymphocytic pleocytosisNormal glucoseSignificant number of red blood cells. Which of the following is the most likely diagnosis?

A 29-year-old female is brought to the trauma bay by EMS after being an unrestrained passenger in a high-speed rollover MVC. She was intubated in the field due to decreased level of consciousness. On exam, you note extensive periorbital ecchymosis bilaterally and ecchymosis over the mastoid processes bilaterally. Otoscopic examination of the right ear reveals a dark, violaceous discoloration behind an intact tympanic membrane. What is your most likely diagnosis based on the patient’s physical exam findings?

A 67-year-old right-handed male is brought to the ED by his wife after she noticed he suddenly began struggling to speak during breakfast. She reports that when she asked him if he was okay, he appeared frustrated and replied, “I… want… the… thing…” while gesturing toward his coffee cup. He was able to follow her instructions to stand up, walk to the car, and buckle his seatbelt without difficulty. On exam, the patient is alert and appears to understand all questions and commands. When asked to describe what happened this morning, he speaks in short, effortful phrases with long pauses. He correctly points to objects in the room when asked and follows multi-step commands. However, when asked to name a pen, he says, “I write… the… it’s for…” and becomes visibly frustrated. Which of the following best characterizes this patient’s language deficit?

A 72-year-old male nursing home resident is brought to the ED by staff after being found increasingly confused over the past 18 hours. PMH: type 2 DM, CKD stage III, and a splenectomy about 20 years ago. His medications include metformin, lisinopril, and a daily aspirin. Vital signs – temp: 100.6°F, BP:102/58 mmHg, HR:108 bpm, and RR: 22 BPM.On exam, he is lethargic and oriented only to self. He has nuchal rigidity, but Kernig and Brudzinski signs are equivocal. There is no rash. LP performed with the following CSF analysis:Opening pressure: elevated Appearance: cloudy WBC: 2,200 cells/μL (92% neutrophils) Glucose: low Protein: elevated Gram stain: Gram-positive diplococci. Given this patient’s presentation, risk factors, and CSF findings, which of the following is the most likely diagnosis?

A 33-year-old woman presents with strange dance-like movements of her hands that she has noticed over the past year. She also reports some mild changes in memory and increasing irritability during this time. Her father died in his early 50s from a MVC but had experienced similar symptoms. What is the most likely diagnosis in this patient?

Which of the following is a risk factor for developing multiple sclerosis?

A 16-year-old male was playing soccer when he fell and hit his head. He lost consciousness for 2 minutes but then awoke and seemed fine to his mother other than complaints of headache, nausea, and vomiting. His mom brings him in because he has since become lethargic, and the headache won’t let up. You notice on exam that his pupils are unequal and sluggish, he also has weakness on his left side. He has a large area of swelling to the right side of his head and CT reveals a skull fracture on the right temporal area. Which of the following is most likely to accompany his skull fracture and cause his symptoms?