Watch the video version of this episode on YouTube - https://youtu.be/rYX0wwlWXZg 

A physical therapist works with a patient on proprioceptive and balance activities due to a history of recent falls. The patient informs the therapist that they have recently been diagnosed with optic neuritis. Which of the following medical conditions is MOST likely associated with the patient’s diagnosis?

1. Parkinson's disease
2. Guillain-Barre syndrome
3. Myasthenia gravis
4. Multiple sclerosis

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist works with a patient on proprioceptive and balance activities due to a history of recent falls. The patient informs the therapist that they have recently been diagnosed with optic neuritis. Which of the following medical conditions is MOST likely associated with the patient’s diagnosis?

1. Parkinson's disease
2. Guillain-Barre syndrome
3. Myasthenia gravis
4. Multiple sclerosis

Optic Neuritis
Optic neuritis refers to inflammation that damages the optic nerve (cranial nerve II), which transmits afferent visual information from the eye to the brain. Because the optic nerve is an extension of the cerebral cortex, it is vulnerable to the effects of demyelination.

Let’s explore each of the options:

Option 1 - Parkinson's disease

Parkinson's disease is a progressive neurological disorder characterized by movement problems, including tremors, stiffness, and slowness of movement, caused by a loss of nerve cells in the brain that produce dopamine.

The early signs of Parkinson’s disease include resting tremors, usually in the hands (e.g., pill-rolling tremor) or feet, that increase with stress and disappear with movement or rest. Although early symptoms can also include balance disturbances, optic neuritis is not associated with Parkinson’s disease.

Option 2 - Guillain-Barre syndrome
Guillain-Barre syndrome, or acute polyneuropathy, is a temporary inflammation and demyelination of the peripheral nerves’ myelin sheaths, potentially resulting in axonal degeneration.

The early signs of Guillain-Barre syndrome include distal symmetrical motor weakness and mild distal sensory impairments. Complications most associated with Guillain-Barre syndrome include muscle and respiratory paralysis, dysphagia, bladder weakness, and autonomic nervous system involvement including arrhythmia, tachycardia, postural hypotension, heart block, and absent reflexes. Optic neuritis is not associated with Guillain-Barre syndrome.

Option 3 - Myasthenia gravis
Myasthenia gravis is a chronic autoimmune disorder that affects the neuromuscular junction due to the body's immune system producing antibodies that block or destroy acetylcholine receptors.

The primary feature of myasthenia gravis is muscle weakness within the skeletal muscles, with other neurologic findings being normal (e.g., reflexes and sensation). Because the ocular muscles are commonly affected, the patient can experience diplopia and ptosis (i.e., drooping eyelid). However, optic neuritis is not associated with myasthenia gravis.

Option 4 - Multiple sclerosis
Multiple sclerosis produces patches of demyelination of the myelin sheaths that surround nerves within the brain and spinal cord. This decreases the efficiency of nerve impulse transmission 

The initial symptoms of multiple sclerosis (MS) can include visual problems, sensory changes, clumsiness, weakness, ataxia, balance dysfunction, and fatigue. Optic neuritis is often one of the first clinical signs of MS, since MS is characterized by demyelination of the myelin sheaths that surround the nerves within the brain and spinal cord. A history of recent falls, proprioceptive and balance impairments, and the presence of optic neuritis result in MS being the most realistic medical condition.

The correct answer is Option 4

Let’s explore the all student data:
4% of students selected Option 1, Parkinson's disease
9% of students selected Option 2, Guillain-Barre syndrome
22% of students selected Option 3, Myasthenia gravis
65% of students selected Option 4, Multiple sclerosis, the correct response

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. 

Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!