07-10-2008, 06:00 AM
A 42-year-old man with secondary progressive multiple sclerosis comes to the local urgent care facility because of increased weakness and spasticity of the legs, with increased hip flexor tone. Over the past 3 days he has also noted an increase in urinary urgency and frequency. Until 3 days ago, he had been fairly stable, with a slowly progressive course, and could walk at least 500 feet with one cane; spasticity had been well controlled with baclofen, 20 mg three times a day orally. On examination, blood pressure is 110/70mm Hg; pulse, 92/min; and temperature, 38.2 C (100.8 F). He has bilateral internuclear ophthalmoplegia. Hip flexion is weak bilaterally. Spasticity is severe in the legs, with sustained clonus at both ankles. Urinalysis shows 50 to 100 leukocytes/hpf, and 2+ leukocyte esterase.
In addition to treatment of the urinary tract infection, which of the following is the most appropriate treatment?
A. Acetaminophen
B. Oral prednisone
C. Intravenous methyiprednisolone
D. Interferon beta
E. Glatiramer acetate
In addition to treatment of the urinary tract infection, which of the following is the most appropriate treatment?
A. Acetaminophen
B. Oral prednisone
C. Intravenous methyiprednisolone
D. Interferon beta
E. Glatiramer acetate