Case 17 - Overview Flashcards
which of these conditions is a chronic immune mediated , inflammatory demyelinating disease of the CNS
a.MS
b.Guillian barre
c.brown squared
d.parkinsons
e.huntingtons
a.MS
what is the most common initial clinical syndrome in MS
a.optic neuritis
b.transverse myelitis
c.brainstem syndrome
a.optic neuritis
MS discovered on an MRI for another reason is known as
a.CIS
b.RIS
b.RIS
radiologically isolated syndrome
unilateral loss of vision , typically worsening over days, loss of colour vision and retrobulbar eye pain made worse by eye movement that improves over weeks or months indicates what
optic neuritis
the visual loss in optic neuritis is
a.unilateral
b.bilateral
a.unilateral
the retrobulbar pain experienced in optic neuritis is usually
a. relieved by movement
b.exacerbated by movement
b.exacerbated by movement
optic neuritis improves over…
a.weeks - months
b.months - years
c.hours - days
d.minutes - hours
a.weeks - months
an area of inflammation within the spinal cord is known as
a.optic neuritis
b.transverse myelitis
c.brainstem syndromes
b.transverse myelitis
Lhermittes phenomenon ( electric shock sensation down spine on neck flexion) is due to a lesion in which part of the spinal cord
a.cervical
b.thoracic
d.lumbar
e.sacral
d.coccygeal
a.cervical
weakness , sensory symptoms , bladder and bowel dysfunction and lhermittes phenomenon is seen in which condition that precedes MS
a.optic neuritis
b.transverse myelitis
c.brain stem syndromes
b.transverse myelitis
vertigo, dysarthria (slurred speech), dysphagia, diplopia, trigeminal neuralgia (one sided facial pain), double vision, ataxia and internuclear ophthalmoplegia indicate which initial clinical syndrome of MS
a.optic neuritis
b.transverse myelitis
c.brain stem syndromes
c.brain stem syndromes
in internuclear ophthalmoplegia (as seen in brainstem syndromes preceding MS) there is…
a.ipsilateral impaired adduction and contralateral nystagmus
b.contralateral impaired adduction and ipsilateral adducting nystagmus
c.ipsilateral abduction and contralateral abducting nystagmus
d.contralateral impaired abduction and ipsilateral abducting nystagmus
a.ipsilateral impaired adduction and contralateral nystagmus. (when abducting)
increased tone, clonus, weakness, hypereflexia and extensor plantar responses are examples of what seen in MS
a, upper motor neurone signs
b.lower motor neurone signs
a, upper motor neurone signs
how does the optic disc appear in MS
a.hard exudates present
b.decreased cup to disc ratio
c, white pale disc
c, white pale disc
optic nerve atrophy
at what age does MS usually onset
a.childhood
b.adolescensce
c.adulthood
d.elderly
c.adulthood
20-40 yrs
MS happens more commonly in ..
a.males
b. females
b. females
which virus is a risk factor for MS
a.epstein barr
b.covid
c.herpes zoster
d.cmv
a.epstein barr
living in which regions increases risk of MS
a.high latitude
b.low latitude
a.high latitude
less UV exposure and less vitamin D
which of these is a modifiable risk factor for MS
a.smoking
b. alcohol
c. obesity
a.smoking
what is the most common subtype of MS
a.relapse remitting
b.secondary progressive
c.primary progressive
a.relapse remitting
85%
how long after onset does relapse remitting become secondary progressive
a.2 yrs
b.5 yrs
c.10 yrs
c.10 yrs
a steady increase in disability without attacks describes which type of MS
a.primary progressive
b.secondary progressive
c.relapsing remitting
a.primary progressive
no new disability between attacks followed by a steady increase in disability describes which type of MS
a.primary progressive
b.secondary progressive
c.relapsing remitting
b.secondary progressive
no new disability between attacks describes which type of MS
a.primary progressive
b.secondary progressive
c.relapsing remitting
c.relapsing remitting
how do MS lesions appear on MRI
a.dark
b.white
b.white
csf is bright white
pathological white fluid shows duller white
in. a FLAIR MRI which signal is nullified
a.fat
b.csf
b.csf
normally bright white
in a T1 MRI which tissue is bright
a.fat
b.csf
c.csf and fat
a.fat
T1- 1 tissue bright
in a T2 which tissue is bright
a.fat
b.csf
c.csf and fat
c.csf and fat.
t2– 2 tissues are bright
ww2 - water is white
what signal is suppressed in. STIR MRI
a.fat
b. csf
a.fat
in a gadolinium enhanced MRI what is enhanced
a.fat
b.csf
d.vasculature
d.vasculature
vascular mimics of MS
small vessels disease
CNS vasculitis
CADASIL
autoimmune MS mimics
acute disseminated encephalomyelitis
neuromyleitis optica
SLE
neurosarcoidosis
infectious mimics of MS
neurosyphilis
HIV
Lyme disease
neuroplastic mimics of MS
primary brain tumour
glioblastis cerebri
CNS lymphoma
genetic mimics of MI
mitochondrial disease
adrenoleucodystrophy
hereditary spastic parapesis
tests to exclude alternative diagnoses before referring to a neurologist
fbc
crp
lft
rat
calcium
glucose
thyroid glucose
b12
HIV
why is a lumbar puncture done for suspected MS
a. look for evidence of infection
b.determine if viral or bacterial
c. look for evidence of inflammation
c. look for evidence of inflammation
presence of what in csf may indicated ms
a.oligoclonal bands
also look t wbc and proteins
wha test demonstrates a delay in signal transmission along the optic nerve
a. MRI
b. eeg
c.emg
d. VER
d. VER
visual evoked response
the risk of ms after CIS (clinically isolated syndrome) is calculated based on what..
MRI lesion load
presence of CSF oligoclonal bands
a focal deficit lasting more than 24 hrs preceded by at least 30 days of clinical stability is known as
a.ms
b.cis
c.ris
d.relapse
d.relapse
confirmed with new or worsened neurological dysfunction
what is important to exclude in relapse management as pseudo relapses can occur as a result of this …
a.infection
b.hormonal changes
c.stress
a.infection
what drugs can be used to speed up recovery in some relapses
a. steroids
b.beta blockers
c.DMARDs
d.SSRIs
a. steroids
which part of the nerve is attacked in MS
a.myelin sheath
b.dendrites
c.external lamina
d.schwann cells
a.myelin sheath
over time the pathophysiology of ms changes from …………… to …………….
a.inflammation, demyelination, remyelination to less inflammation , more axonal loss
b.less inflammation , more axonal loss to inflammation, demyelination and remyelination
a.inflammation, demyelination, remyelination to less inflammation , more axonal loss
what is the purpose of treatment in MS
a. curative
b.disease modifying
b.disease modifying
act on immune system to reduce inflam and demyelination
reduce relapse rate
may improve long term disability
in clinically isolated syndromes what is the purpose of DMT
can delay time until 2nd relapse
decreased brain atrophy rate
what drugs are used in patients with active disease and more than 2 clinical relapses in prev 2 years
a.moderate efficacy - interferon beta, glatiramer acetate, teriflunomide
b.high efficacy - natilizumab, alemtuzumab
a.moderate efficacy - interferon beta, glatiramer acetate, teriflunomide
what drugs are used in patients with more active disease and frequent relapses
a.moderate efficacy - interferon beta, glatiramer acetate, teriflunomide
b.high efficacy - natilizumab, alemtuzumab
b.high efficacy - natilizumab, alemtuzumab
what drug is given in active secondary progressive MS
a. interferon beta
b.ocrelizumab
c. siponimod
d. natilizumab
c. siponimod
what drug is used to treat active primary progressive MS
a. interferon beta
b.ocrelizumab
c. siponimod
d. natilizumab
b.ocrelizumab
which drug is used for neuropathic pain (sharp stabbing burning sensation) in ms
a.gabapentin
b.ocrelizumab
c.siponimod
d.baclofen
e.anti cholinergic
d.anxiolytics
a.gabapentin
which drug is used for spacisitiy in ms
a.gabapentin
b.ocrelizumab
c.siponimod
d.baclofen
e.anti cholinergic
d.anxiolytics
d.baclofen
which drug is used for bladder overactivity in ms
a.gabapentin
b.ocrelizumab
c.siponimod
d.baclofen
e.anti cholinergic
d.anxiolytics
e.anti cholinergic
which drug is used for mood disorder in ms
a.gabapentin
b.ocrelizumab
c.siponimod
d.baclofen
e.anti cholinergic
d.anxiolytics
d.anxiolytics
