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Question 1

Multiple sclerosis

• define
• age/ sex
• RF
• patho
• patterns
• symptoms
• Ix
• Mx - general
• Mx - complications
• Mx - acute

Answer 1

define
- autoimmune demyelination of CNS

age/ sex

• 2:1 F:M
• 20-45Y

RF
- HLA-DR2

patho

• sensory changes - dorsal, proprioception, paraesthesia
• optic sx
• umn - hemi/ monoparesis
• cerebellar
• angles of lat ventricles
• triggers - illness, fever, hot weather, post-exercise, pregnancy (signals De with temp)

patterns
- primary progressive - 10-15%
– older people, progressive from onset
- relapsing-remitting - 80-85%&raquo_space; secondary
progressive
– progress to secondary w/in 15Y from dx

symptoms - optic

• optic sx - loss vision, loss colour vision, pain with movement, swollen optic disc, diplopia
• uhthoff’s phenomenon - worsening vision with IN body temp
• internuclear opthlamoplegia - uncoord eye movements
• optic atrophy

symptoms - cerebellar
- cerebellar - nystamus, intention tremor

symptolms - sensory

• dorsal post cervical lesion - paraesthesia, De proprioception in 1 limb or half body
• • l’hermitte’s sign - neck flexion causes shooting pain down arms and legs
• corticospinal - para/hemi/ monoparesis
• trigem neuralgia, bulbar palsy, numbness, pins/ needles
• spastic weakness in legs

symptoms - other

• brainstem - bladder or bowel dysfunction (incontinence or constipation, frequency and urgency), erectile dysfunction, diplopia
• congitive impairment - DE IQ, language problems

Ix

• bloods - FBC, UE, ESR, CRP, glucose
• MRI - periventricular plaques
• LP - oligoclonal IgG bands, IN protein,
• visual evoked potentials - delayed occiptal EEG reactions

Mx - general

• stop smoking, exercise
• DMTs - teriflunomide, dimethyl fumerate
• natalizuab

Mx - complications

• fatigue - amatadine, CBT
• spasticity - baclofenac, botox injection
• ataxia/ temor - OT, PT
• mental health - CBT
• sex - sildefanil men
• bladder - >100ml ICS, <100ml antimuscarinic
• pressure sores - movement and PT

Mx - acute

• 0.5mg methylpred p.o 3D
• social care help

Question 2

thyroid cancer

• types
• Ix
• each type:
• • what
• • age
• • present
• • Mx
• • prog

Answer 2

types
- papillary, follicular, medullary, anaplastic, lymphoma

Ix

• history
• exam - head and neck
• bloods - FBC, TFT
• CT neck/ chest
• USS - cyst?
• technetium scan - hot adenoma, cold malignancy
• FNAC

papillary

• most common, 70%
• 40-50Y
• present - local mets
• mx - surg resection and ablative radio-iodine
• good prog

follicular

• second most common, 20%
• mets via blood to bone
• mx - surg resection and albative radio-iodine
• good prog

medullar

• adults, MEN2 children
• parafollicular c cells&raquo_space; calcitonin
• slow grow and poor prog

anaplastic

• rare, <5%
• elderly
• locally invasive - SVC, trachea obstruction
• mx - thyroidectomy and external readiotherapy
• poor prog