Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro II - Final Content > 10/28 - Multiple Sclerosis - Physical Therapy and Rehabilitation > Flashcards

10/28 - Multiple Sclerosis - Physical Therapy and Rehabilitation Flashcards

1
Q

What is the role/function of the microglia cells? T cells? B cells?

A

Microglia- are a type of CNS macrophages /white blood cell that ingest the antigen (foreign body/ bad guy) and present it to the T an B cells
T cells- responsible for cell destruction
B cells - responsible for antibody production
Both T an B cells have memory of the antigens and will mark them for destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are cytokines and how do they play a role in immune defense?

A

Cytokines stimulate activity in B cells, macrophages and T cells and open the blood brain barrier -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What goes wrong in these processes and causes demyelination?

A

Myelin and myelin producing cells both get tagged as an antigen (bad guy) causing the microglia to identify the myelin as bad and present it to the T and B cells which create an antibody that marks the myelin as a foreign substance and causes it to be attacked by macrophages and T cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What process has a major role in the progressive nature of MS?

A

Direct Axonal Damage- when the autoimmune system attacks the axon instead of the myelin causing un-repairable degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the take home point about all of these immune system processes?

A

It is a mutlifaceted inflammatory process of demyelination and progressive neurodegeneration. There is not just one cause!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the most common lesion locations for MS?

A

Supratentorial brain structures- periventricular, corpus callosum, optic nerve
Infratentorial brain structures- cerebellum, brainstem
Spinal Cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a “lesion”?

A

Lesions are pro-inflammatory degeneration of the axons that clause plaque formations which “sclerose” the nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What area of the spinal cord is typically most affected in MS?

A

The cervical spinal cord. Typically don’t see it in the thoracic and lumbar spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When the corpus callosum has a lesion, what deficits will be present?

A

Cognitive deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When the supratentorial region is sclerosed, what deficits will be present?

A

Both cognitive and physical disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the LARGEST predictor of long term disability?

A

> 2 lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What specific deficits are seen when there is a lesion located in the inratentorial region?

A 
Coordination and tremors
Upright postural control is affected
Eye movement and lack of visual stability
        - Saccades
         - VOR
        - Smooth pursuit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common eye movement disorder with MS? How do you diagnose the disorder?

A

Internucelar opathlmoplegia (INO) - decreased control of the ability to adduct the eye.

Use tracking to diagnose the issue - can be seen with convergence and divergence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the largest predictor of level of disability in MS?

A

Cervical lesion load (the number of lesions and their size)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What deficit does the presence of a lesion in the spinal cord cause ?

A

Significantly affects the ability to ambulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If gray matter is involved in the lesion is prognosis better or worse?

A

It is worse because the cell body is affected and causes progressive/ chronic stages of MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does gray matter involvement affect seizure frequency? Cognition? Physical disability?

A

Seizure - 6x greater than the general population
Cognition -
White matter loss- causes issues in mental processing speed and memory
Gray matter loss- causes verbal memory, euphoria, disinhibition

Physical disability - as measures by the expanded disability status scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Epidemiology - who gets MS? how old are they?

A

Women - mostly caucasian between 15-45 y/o

Alot in CO!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

T/F genetic and congenital background is mostly attributed to how MS is contracted

A

False- no one knows- it could be genetic, it also could be after a viral infection ( have a 2/3rd higher risk of MS after having mono)
Could be due to Vitamin D deficiency….

NO ONE KNOWSS!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does Vit D supplements affect the inflammation process?

A

With supplements there can be a reduction of activity of the T cells, B cells or cytokines
Vit D supplements are GREAT! It has a neuroprotective effect
2000-4000 IU/day of Vit 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F - people that smoke have a 50% higher risk of MS

A

True!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

T/F - people that live south of the equator have a higher risk of MS

A

False- north of the equator have a higher risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which test confirms the diagnosis of MS?

A 
NONE. There is no specific test
History
Clinical exam
Paraclinical exam-  MRI/ spinal tap
Rule out other plausible diagnoses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What defines an Ms “Attack”

A

Deterioration in function that follows typical symptoms of MS- loss of vision, loss of sensation, mobility issues that lasts > 24 hours and is greater than 30 days of separation from attack 1 to attack 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What should the clinical exam include?

A

Cranial nerve screen

26
Q

How do you screen for CN II?

A 
CN II- Snellen chart
Scotoma-  visual blind spot
Reduction of color
distortion of color
Anopsia-  loss of visual field
27
Q

How do you screen for CN II, IV, VI?

A

Tracking-smooth pursuit and convergence/ divergence
Saccades
VOR

28
Q

How do you screen for VII?

A

Light touch/ sharp or dull

Facial muscle function

29
Q

How do you screen for VIII

A

Hearing and Vestibular systems

30
Q

Screen for VII IX X XII

A

Dysarthria

31
Q

Screen for IX X

A

Dysphagia

32
Q

CN XI

A

Trapezius motor function

33
Q

CN XII

A

Tongue function and alignment

34
Q

CN XII - you are testing the tongue - if you have the person stick out their tongue which way will the tongue deviate if the nerve is affected?

A

It will deviate TOWARDS the side of the lesion

35
Q

What else do you want to examine in a patient with MS?

A 
ALL neuro functions
Reflexes-  clonus/ babinski
Tone / spasticity
intentional movement - tremor, dysdiadochokinesia
Sensation
Proprioception/positioning/vibration
Motor function
Functional tests
Self report measures
36
Q

In the EDSS- steps 1.0-4.5 refer to people who have what function? Steps 5.0-9.5?

A
  1. 0-4.5 Fully ambulatory

5. 0- 9.5 defined by the impairment to ambulation

37
Q

What is included in the paraclinical exam?

A

MRI

Spinal tap of the CSF

38
Q

An MRi supports the identification of lesions in both time and space. How do you define time in regards to lesion? Space?

A

Time- new lesions that have developed and/or lesions that have progressed

Space- lesions in two or more locations - ie paraventricular, juxtacortical, infratentorial, spinal cord

39
Q

When should someone have a spinal tap?

A

When their clinical presentation is atypical, when the MRI is unspecific, to rule other dx.

40
Q

What constitutes a positive spinal tap?

A

Presence of oligoclonal bands- antibodies are in the CNS where they shouldnt be - because of cytokines

41
Q

What are the 4 difference subtypes of MS?

A

Relapse Remitting - 85%
Secondary Progressive- 1/2 of relapse remitting will convert to secondary progressive
Primary progressive - 10-15%
Progressive - relapsing - rare subtype of ms
Clinically isolated syndrome - One episode of MS attack that does not stay

42
Q

If someone has a CIS, what are the chances of a second attack?

A

It increases with time, if you have a 2nd attack there is a definite clinical diagnosis of MS

43
Q

T/F in early stages re-myelination occurs more frequently than in later stages

A

True!

44
Q

Who is more likely to have re-myelination?

A

Someone with an early diagnosis of MS, Women, subcortical and periventricular lesion areas

45
Q

What is the prevalence of cognitive impairment in people with MS? what deficits are commonly present?

A

70%
Short term memory, attention/concentration, speed of processing, executive function
Dementia is rare - intelligence is usually intact

Worsens with grey matter involvement, lesion load, 3rd ventricle size and brain atrophy

46
Q

How prevalent is fatigue in the MS population? What causes it?

A 
86%
sleep disturbance due to pain/spasticity/bowel or bladder
metabolic issues/depression
medications
depression
excessive exercise / activity
47
Q

How prevalent are visual disturbances in the MS population? What deficits are typically present?

A 
80% 
Optic neuritis
Positional vertigo / nystagmus
Eye movements - tracking and fixation
Vestibular issues
48
Q

How prevalent is depression in this population?

A

50%

49
Q

What are common triggers for hypertonicity/ spasticity in people with MS?

A

Fatigue/ weakness
infection (UTI)
Heat
Medications

50
Q

How prevalent is pain in people with MS?

A

86%

Correlated with increased age, disability, disease duration, progressive stages

51
Q

What are some negative prognostic factors?

A 
Older age at onset is worse
male
african american
high relapse rate - in first 5 years
Primary progressive type of MS
Early motor/cerebellar disability
high lesion load and brain atrophy
early requirement of AD's
52
Q

What are the 2 largest correlates to disability

A

Location - periventricular

Lesion load

53
Q

How much is the life span impacted by MS?

A

decreases by 6-7 years

54
Q

What are the types of medical management approaches?

A

Acute attack treatment
Drug therapies- proactive
symptom management

55
Q

What are some of the side effects of corticosteroids?

A 
increased agitation/anxiety
driving restriction
insomnia 
infection of IV site 
decreased bone mineral density
56
Q

What is plasma exchange reserved for as treatment?

A

for severe attacks- if unresponsive to steroids

57
Q

What are reasons for early treatment in MS?

A

therapies both medical and physical are less effective later in the disease state
try to improve symptoms and physical function ASAP

58
Q

What are the ABC drug therapies and what is their purpose?

A

Interferon B 1a- Avonex/Rebif
Interferon B 1b- Betaseron
Glatiramer Acetate - Copaxone

Goals- ALL reduce attacks, stabilize progression of MRI changes,
Interferon B - slows progression of disability

59
Q

T/F - Someone with a CIS who is treated early with an Interferon 1a has a higher likelihood (1:7) of not converting to MS

A

TRUE!!!!! Early treatment is good!

60
Q

What is the name of the drug that is life threatening and can cause a brain disorder if taken?

A

Natalizumab - progressive multi-focal leukoencephalopathy

Neuro II - Final Content (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions