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Neurology Week 4 2018/19 > 3: Multiple sclerosis > Flashcards

3: Multiple sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

Inflammatory demyelinating disease of the CNS

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2
Q

Multiple sclerosis is more common in (men / women).

A

women

3:1

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3
Q

At what age do people tend to develop multiple sclerosis?

A

30s - 40s

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4
Q

Multiple sclerosis is an ___ disease.

A

autoimmune

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5
Q

What does “disseminated in time and place” mean in relation to multiple sclerosis?

A

Lesions have to have developed

in different areas of the CNS

at different times

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6
Q

What is pyramidal dysfunction?

A

Problems affecting the pyramidal tracts i.e the corticospinal tract and corticobulbar tract

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7
Q

What do the

a) corticospinal tract
b) corticobulbar tract

control?

A

a) Voluntary movement

b) Movement re: cranial nerves

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8
Q

Pyramidal dysfunction causes (motor / sensory) symptoms.

A

motor symptoms

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9
Q

What are some examples of pyramidal dysfunction caused by multiple sclerosis?

A

Increased muscle tone

Muscle spasm

Weakness

Tremor

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10
Q

What is optic neuritis?

A

Inflammation of the optic nerve

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11
Q

What eye problems are caused by multiple sclerosis?

A

Optic neuritis (inflammation of optic nerve)

Nystagmus

Diplopia

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12
Q

What is the main complaint of optic neuritis?

A

Painful visual loss

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13
Q

What sign will you see on examination of the eyes of a patient with optic neuritis?

A

Relative afferent pupillary defect

swinging light test

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14
Q

What sensory symptoms do patients with multiple sclerosis complain of?

A

Pain

Tingling (paraesthesia)

Numbness

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15
Q

People with multiple sclerosis may lose their sense of proprioception and vibration.

Which sensory pathway is responsible for these?

A

DC/ML pathway

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16
Q

Which nerve is affected if a patient with MS complains of facial pain?

A

Trigeminal nerve (CN V)

17
Q

Which part of the brain, controlling coordination, is affected in MS?

A

Cerebellum

18
Q

MS causes cerebellar symptoms.

What is Charcot’s triad of MS?

A

Dysarthria (slurred speech)

Tremor

Nystagmus

19
Q

Which cranial nerves are affected if an MS patient complains of

a) diplopia
b) facial weakness?

A

a) CN III, IV or VI
b) CN VII

20
Q

Patients with MS will complain of constant ___.

A

fatigue

21
Q

Which investigations are used to diagnose MS?

A

Neuro exam

MRI scan (to pick up lesions)

Lumbar puncture (to examine CSF)

Blood tests (for autoantibodies and to rule out other diseases)

22
Q

What are the Mcdonald criteria for diagnosing MS?

A

TWO episodes of symptoms suggesting demyelination

“Dissemination in time and place”

23
Q

Why is the CSF examined in patients with suspected MS?

A

‘Oligoclonal bands’ in the CSF is highly predictive of MS

24
Q

MS can ___ causing acute exacerbations.

A

flare

25
Q

How are mild exacerbations of MS treated?

A

Symptomatic treatment

Baclofen and physio referral for motor symptoms

Gabapentin and amitriptyline for neuropathic pain

26
Q

Why aren’t normal analgesics e.g paracetamol used in the symptom management of MS?

A

Not effective for neuropathic pain

27
Q

How are moderate exacerbations of MS treated?

A

Oral steroids

Immunosuppressant remember

28
Q

How are severe exacerbations of MS treated?

A

Admission to hospital

IV steroids

29
Q

Which anti-spasmodic drug is used to relieve motor symptoms of MS?

A

Baclofen

30
Q

Which AHPs are involved in the management of motor symptoms of MS?

A

Physiotherapist

Occupational therapist

31
Q

Which drugs are used to manage the sensory symptoms of MS?

A

Gabapentin

Amitriptyline

32
Q

Which class of drug is used to treat urge incontinence caused by MS?

Name an example?

A

Antimuscarinic

Oxybutynin, Tolterodine

33
Q

Which illegal drug has been proven to give symptomatic relief in MS?

A

Cannabis

34
Q

Which drugs are used to help control

a) motor
b) sensory

symptoms of MS?

A

a) Baclofen (muscle relaxant)

b) Gabapentin (anticonvulsant), amitriptyline (antidepressant)

35
Q

Does symptomatic treatment halt the progress of MS?

A

No

36
Q

MS progresses in (the same way / different ways) in individual patients.

A

different ways

37
Q

Which three immunosuppressants can be used first-line in the treatment of MS?

A

Interferon beta

Copaxone

Tecfidera

just memorise this like the MSK one

Neurology Week 4 2018/19 (12 decks)

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