{"id":6146,"date":"2025-06-18T00:01:13","date_gmt":"2025-06-18T08:01:13","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=6146"},"modified":"2025-10-01T11:38:25","modified_gmt":"2025-10-01T19:38:25","slug":"usmle-step-1-question-of-the-day-multiple-sclerosis","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-multiple-sclerosis","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Multiple sclerosis"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-multiple-sclerosis\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-multiple-sclerosis\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-multiple-sclerosis\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-multiple-sclerosis\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-multiple-sclerosis\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Can you determine the most likely diagnosis for a 41-year-old woman who visits her outpatient provider to evaluate muscle pain and tightness that&#8217;s more prominent in the lower extremities and worsen with movement<\/strong><\/em><strong><em>? Let&#8217;s learn more about the case!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 41-year-old woman presents to her outpatient provider to evaluate muscle pain and tightness. These symptoms are most prominent in the lower extremities and worsen with movement. She currently has difficulty ambulating and requires assistance with a walker. Past medical history is notable for hypertension, hyperlipidemia, and poorly-controlled multiple sclerosis. She experiences multiple acute exacerbations of multiple sclerosis each year and currently takes glatiramer acetate. Temperature is 37.3\u00b0C (99.1\u00b0F), blood pressure is 148\/93 mmHg, and pulse is 67\/min. Increased muscle tone is present in the bilateral lower extremities on physical examination. There is resistance to active and passive range of motion in the foot and ankle joints, which is more prominent with rapid movements. The patient is started on a new medication to treat muscle spasticity. This medication\u2019s side effects include hyporeflexia, sedation, and tolerance with prolonged use. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Which of the following <strong>best <\/strong>describes this medication\u2019s mechanism of action?<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Activation of GABA receptors within the spinal cord<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Inhibition of ryanodine receptors in muscle cells<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Induction of B-cell and T-cell apoptosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Inhibition of cyclooxygenase enzymes<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Antagonization of 5-HT2 receptors within the spinal cord<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Activation of GABA receptors within the spinal cord<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Inhibition of ryanodine receptors in muscle cells<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Dantrolene inhibits ryanodine receptors, thereby reducing calcium release from the sarcoplasmic reticulum of muscle cells. Dantrolene can be used to treat neuroleptic malignant syndrome and malignant hyperthermia. However, this medication is not used to treat muscle spasticity that develops as a complication of multiple sclerosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Induction of B-cell and T-cell apoptosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Glucocorticoids are a class of immunosuppressants that work via several mechanisms, one of which is induction of immune cell apoptosis. Intravenous glucocorticoids are effective for treating acute flares of multiple sclerosis. However, the medication would not be effective in treating muscle spasticity as a complication of poorly-controlled multiple sclerosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Inhibition of cyclooxygenase enzymes<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase enzymes, thereby reducing prostaglandin synthesis. NSAIDs effectively treat musculoskeletal pain but are not typically used to treat muscle spasticity.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Antagonization of 5-HT2 receptors within the spinal cord<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Cyclobenzaprine is a centrally-acting muscle relaxant. Its exact mechanism of action is unclear, but the medication is thought to antagonize 5-HT2 receptors within the spinal cord. Cyclobenzaprine is more commonly used to treat musculoskeletal pain (e.g. low back pain) and fibromyalgia, but not muscle spasticity that arises from multiple sclerosis.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient with multiple sclerosis presents with muscle spasticity, defined as a velocity-dependent increase. Baclofen therapy can be used for symptomatic management.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Baclofen is a muscle relaxant that activates presynaptic and postsynaptic \u03b3-aminobutyric acid b (GABA b) receptors within the spinal cord. In the presynaptic membrane, baclofen increases potassium efflux and reduces calcium influx, leading to decreased excitatory neurotransmitter glutamic acid release. In the postsynaptic membrane, baclofen reinforces the action of the inhibitory neurotransmitter GABA. As a result, baclofen causes muscle relaxation both presynaptically and postsynaptically.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Baclofen is indicated for managing muscle spasticity caused by chronic neurological disorders, such as multiple sclerosis or cerebral palsy. In addition, baclofen can treat dystonia, which is characterized by involuntary muscle contractions that result in abnormal movements or postures.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Side effects include hyporeflexia, muscle weakness, hypothermia, drowsiness, and hypotension. In rare cases, baclofen can also lead to coma. Chronic baclofen use can lead to tolerance, which means that patients develop progressively reduced responses to the medication and, therefore, an increased dose to achieve the initial response.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Baclofen is a muscle relaxant that activates GABA b receptors within the spinal cord. The condition can be used to treat muscle spasticity as well as dystonia. Side effects include muscle weakness, drowsiness, and tolerance to prolonged use.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ghanavatian, S., Derian, A. (2020) \u201cBaclofen\u201d. <em>StatPearls [Internet]<\/em>. Web Address: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK526037\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK526037\/<\/a>.&nbsp;<\/li>\n\n\n\n<li>Patejdl, R., Zettl, U.K. (2017) Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions. <em>Autoimmunity Reviews<\/em>. 16(9), 925-936. Doi: 0.1016\/j.autrev.2017.07.004.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore today\u2019s USMLE\u00ae Step 1 question focusing on muscle spasticity in multiple sclerosis and discover the mechanism of action for baclofen as a treatment option.<\/p>\n","protected":false},"author":202,"featured_media":6153,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,16,1366,1369,44],"tags":[814,796,215,811,813,812,815,149,261,185],"class_list":["post-6146","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-baclofen","tag-clinical-management","tag-healthcare-education","tag-multiple-sclerosis","tag-muscle-spasticity","tag-neurological-disorders","tag-nursing-pharmacology","tag-patient-care","tag-pharmacology","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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Learn which medication carries the highest risk and how atypicals are named.","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE Step 1 Question of the day: Antipsychotic medication","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/Step-1-Question-of-the-day-Antipsychotic-medication.png 2x"},"classes":[]},{"id":3222,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence","url_meta":{"origin":6146,"position":5},"title":"USMLE\u00ae Step 2 CK Question of the Day: Urgency Incontinence","author":"Marina Horiates Kerekes, MD &amp; Team","date":"September 15, 2021","format":false,"excerpt":"We're back with a USMLE\u00ae Step 2 CK Question of the Day!\u00a0Today's case involves a 31-year-old woman with urinary incontinence. Which of the following interventions is used in treating this patient\u2019s condition? A 31-year-old woman has come to an outpatient clinic for urinary incontinence over the past week. 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