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The Plaque Thing!

Topic: Adult

Created on Wednesday, October 22 2008 by rednucleus

Last modified on Thursday, November 20 2008.

A 24-year-old woman has been diagnosed with relapsing-remitting multiple sclerosis 2 years ago, for which she takes "interferon beta 1a" injections. During the past year, she had 5 relapses, 3 of them had necessitated the use of steroid infusions. Examination reveals spastic paraparesis of grade 4 minus with up-going planters and right sided optic atrophy with bi-directional gaze evoked nystagmus. She is ambulant without aids. Which one of the following is true?

A) Decrease the current dose of her interferon beta 1a injections

B) Add interferon beta 1b to her current treatment

C) Increase the current dose of her interferon beta 1a injections

D) Switch to "interferon beta 1b" injections

E) Stop her beta interferon injections

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This question was created on October 22, 2008 by rednucleus.
This question was last modified on November 20, 2008.

ANSWERS AND EXPLANATIONS

A) Decrease the current dose of her interferon beta 1a injections

This answer is incorrect.

Would further increase her relapses. (See References)


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B) Add interferon beta 1b to her current treatment

This answer is incorrect.

Till now, there is no place for combining interferon beta 1a and 1b injections. (See References)


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C) Increase the current dose of her interferon beta 1a injections

This answer is incorrect.

Will not affect the outcome. Besdies, clinical guidelines do not support this act. (See References)


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D) Switch to "interferon beta 1b" injections

This answer is incorrect.

Failure of one beta interferon predicts future failure of the other. (See References)


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E) Stop her beta interferon injections

This answer is correct.

The objective of giving beta interferon injections is to reduce relapse frequency and severity. The occurrence of at least 3 relapses (which are treated with steroid infusions) while the patient is receiving beta interferon means failure of interferons. These should be stopped and another form of immunotherapy should started. (See References)


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References:

1. CarrÃ¡, A., Onaha, P., Luetic, G., Burgos, M., Crespo, E., Deri, N., Halfon, M., Jaacks, G., LÃ³pez, A., Sinay, V., and Vrech, C. (2008). "Therapeutic outcome 3 years after switching of immunomodulatory therapies in patients with relapsing-remitting multiple sclerosis in Argentina." Eur J Neurol, 15(4) 386-93. (PMID:18353125)


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FrontalCortex.com -- Neurology Review Questions -- Neurology Boards -- Board Review -- Residency Inservice Training Exam -- RITE Exam Review
adult
The Plaque Thing!
Question ID: 102308083
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/22/2008
Modified: 11/20/2008
Estimated Permutations: 120