I am a first year Physiotherapy student here in the UK and I have some practice case studies to look at and practice with before a practical examination in September. The exam briefly consists of identifying the patient problems, explaining different intervention options and then performing examples of the chosen interventions. One of the practice materials is a 29 year old female with recently diagnosed relapsing-remitting MS and I am having trouble formulating a patient problem list. In the exam they only want a maximum of 3 problems as the exam is timed. Here is the case study below:

PC Referred to your outpatient clinic by neurologist to treat current S&S and discuss long-term management. Patient presenting with a recent history of trips but has not fallen. Hyperreflexia especially in the L lower limb. She has widespread muscle weakness, which is affecting her confidence in the kitchen and taking care of her children.
HPC 5/12 ago noticed difficulty with routine tasks e.g. getting up from the floor when playing with the children. Needed to steady herself feeling unbalanced as though her R knee would give way. However, this settled and improved so did not bother the GP. 2/12 later she dropped a cup and felt clumsy her arm and hand would shake when she was carrying out an activity (ATAXIA). Again, the S&S went away quite quickly. A month ago, she had an episode of blurred vision and unable to see colour, so she went to see the GP who referred her to a neurologist. After multiple investigations, she has a diagnosis of relapsing remitting MS 1/52 ago.
PMH Nil of note
SH She lives with her partner and 3 young children. She is a current smoker of 10/day. She is a full-time nurse working in cardiac care and she works her shifts around her family. She commutes by car to work and lives in a terraced house with 3 bedrooms and a toilet upstairs.
S She is complaining of fatigue and that she has to keep resting during the day. She is feeling overwhelmed by her diagnosis and how this going to impact her life and her family going forward. She tells you about her recent trips and the problems she is having taking care of her children. Patient states she has reduced confidence 6/10
O Patient walks in with wide BOS and is having problems clearing the floor with her left foot. On examination, she has widespread muscle weakness of 4/5 (oxford scale) and increased resistance to PROM especially in the Left LL. Romberg’s test 40 seconds.

Some of the patient problems I have come up with is widespread muscle weakness and problems with gait. I also highlighted recent history of trips, however I am unsure. I also need to explain what parts of the subjective history indicate that this is a problem. Do you guys think I am on the right lines with my patient problem list? What would you suggest from the case study? This is one of the few practice case studies I have looked at so I want to feel confident before my exam in September and when I go onto placement in November.

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