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MM Test 3 > B6.044 Prework 1: MS Symptoms and Diagnosis > Flashcards

B6.044 Prework 1: MS Symptoms and Diagnosis Flashcards

1
Q

central symptoms of MS

A

fatigue
cognitive impairment
depression
unstable mood

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2
Q

visual symptoms of MS

A

nystagmus
optic neuritis
diplopia

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3
Q

speech symptoms of MS

A

dysarthria

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4
Q

throat symptoms of MS

A

dysphagia

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5
Q

MSK symptoms of MS

A

weakness
spasms
ataxia
loss of balance

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6
Q

sensation symptoms of MS

A

pain
hypoesthesias
paraesthesias (tingling)

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7
Q

bowel symptoms of MS

A

incontinence

diarrhea or constipation

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8
Q

urinary symptoms of MS

A

incontinence

frequency or retention

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9
Q

primary factors influencing diagnosis of MS

A

no single test
based on clinical exam, history, lab tests, and MRI
based on lesions being disseminated in time and space

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10
Q

criteria for MS diagnosis

A

McDonald Criteria

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11
Q

importance of early/effective treatment of MS

A

limits permanent damage to the CNS

may slow or prevent conversion to a more progressive form

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12
Q

2 clinical attacks

2 lesions with objective clinical evidence

A

no other data needed

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13
Q

2 clinical attacks

1 lesions with objective clinical evidence

A

need dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI

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14
Q

1 clinical attacks

2 lesions with objective clinical evidence

A

dissemination in time demonstrated by an additional clinical attack by MRI
OR
demonstration of CSF specific oligoclonal bands

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15
Q

1 clinical attacks

1 lesions with objective clinical evidence

A

need dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI
AND
dissemination in time demonstrated by an additional clinical attack by MRI
OR
demonstration of CSF specific oligoclonal bands

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16
Q

4 types of MS

A 
relapsing remitting (85%)
secondary progressive (50% of relapsing remitting patients within 15 years)
primary progressive (15%)
progressive relapsing (?)
17
Q

what is a relapse

A
  • monophasic clinical episode with patient reported symptoms and objective findings typical of MS
  • represent focal or multifocal inflammatory demyelinating event in the CNS developing acutely or subacutely
  • duration of at least 24 hours
  • with or without recovery
  • absence of fever or infection
18
Q

relapsing and remitting course

A

characterized by relapses with stable neurological disability between episodes

19
Q

sequence of events in a relapse

A

symptoms develop over hours to days
symptoms can continue worsening for several weeks
symptoms slowly subside over weeks to months
residual symptoms can be present

20
Q

definition of progressive MS

A

steadily increasing objectively documented neuro disability independent of relapses
fluctuation, periods of stability, and superimposed relapses might occur

21
Q

events in progressive MS

A

gradual progression

often involves asymmetric leg weakness, ataxia, and spasticity

22
Q

diagnostic criteria of progressive MS

A
  1. one year of disease progression
    PLUS 2 of the 3:
    -evidence for DIS in the brain based on >1 T2 lesions in at least 1 area characteristic for MS
    -evidence for DIS in spinal cord based on >2 T2 lesions in the cord
    -positive CSF for oligoclonal bands and/or elevated IgG index
23
Q

different activity levels of progressive MS

A

active with progression (relapses and clinical deterioration not due to relapses)
active but without progression (relapses but no clinical deterioration)
not active but with progression
not active and without progression (stable)

24
Q

what is clinically isolated syndrome

A

first presentation of neuro symptoms lasting at least 24 hours
caused by inflammation and/or demyelination
can be monofocal or multifocal
partial or complete recovery
high chance of developing MS

25
Q

etiology of initial relapses in relapsing-remitting disease

A

frequent inflammatory events that reach over the clinical threshold

26
Q

axon loss in relation to MS

A

early axon loss occurs
does not correlate with inflammation
clinical disability over time parallels axonal loss
axonal loss > clinical threshold initiated secondary progressive disease course

27
Q

what can cause axonal loss

A

cyclical demyelination and remyelination events

28
Q

appearance of MS lesions on T2 MRI

A

white lesions
appear fluffy
can appear in white matter, corpus callosum, and spinal cord

29
Q

appearance of MS lesions on T1 MRI

A

IV admin of Gd reveals focal areas of BBB disruption

identified as high signal intensity regions

30
Q

cortical lesions in MS

A

can occur early and may have some relationship with cognitive impairment and physical disability
some cortical lesions observed by pathological examination are not detectable by MRI

31
Q

spinal cord lesions

A

sensory and motor deficits on one or both sides below the lesion

32
Q

brainstem lesions

A

diplopia, ataxia, weakness, altered sensation of the face

33
Q

optic nerve lesions

A

blurry vision

painful eye movements

34
Q

cerebral lesions

A

most common
cause least amount of symptoms
many are silent
if very large: numbness or weakness or other cortical function

35
Q

better prognostic factors for RRMS

A 
female
younger age
white
monofocal onset
minimal cortical pathology
onset w optic neuritis or isolated sensory symptoms
low relapse rate
high degree of remission after 1st relapse
long interval to 2nd relapse
mild relapse
early ttx
absence of oligoclonal IgG or IgM bands
low disability at 5 years
low lesion load on MRI
36
Q

worse prognostic factors for RRMS

A 
male
older age
nonwhite
multifocal onset
early cortical pathology
onset w motor, cerebellar or bladder/bowel symptoms
high relapse rate
short interattack latency
short interval to 2nd relapse
severe relapse
late ttx
presence of oligoclonal IgG or IgM bands
 disability at 2 or 5 years
abnormal MRI

MM Test 3 (31 decks)

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