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neurology 1 > Case 17 - Overview > Flashcards

Case 17 - Overview Flashcards

1
Q

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

a.MS

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2
Q

what is the most common initial clinical syndrome in MS

a.optic neuritis
b.transverse myelitis
c.brainstem syndrome

A

a.optic neuritis

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3
Q

MS discovered on an MRI for another reason is known as

a.CIS
b.RIS

A

b.RIS

radiologically isolated syndrome

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4
Q

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

A

optic neuritis

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5
Q

the visual loss in optic neuritis is

a.unilateral
b.bilateral

A

a.unilateral

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6
Q

the retrobulbar pain experienced in optic neuritis is usually

a. relieved by movement
b.exacerbated by movement

A

b.exacerbated by movement

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7
Q

optic neuritis improves over…

a.weeks - months
b.months - years
c.hours - days
d.minutes - hours

A

a.weeks - months

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8
Q

an area of inflammation within the spinal cord is known as

a.optic neuritis
b.transverse myelitis
c.brainstem syndromes

A

b.transverse myelitis

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9
Q

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

a.cervical

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10
Q

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

A

b.transverse myelitis

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11
Q

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

A

c.brain stem syndromes

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12
Q

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

a.ipsilateral impaired adduction and contralateral nystagmus. (when abducting)

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13
Q

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

a, upper motor neurone signs

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14
Q

how does the optic disc appear in MS

a.hard exudates present
b.decreased cup to disc ratio
c, white pale disc

A

c, white pale disc

optic nerve atrophy

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15
Q

at what age does MS usually onset

a.childhood
b.adolescensce
c.adulthood
d.elderly

A

c.adulthood

20-40 yrs

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16
Q

MS happens more commonly in ..

a.males
b. females

A

b. females

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17
Q

which virus is a risk factor for MS

a.epstein barr
b.covid
c.herpes zoster
d.cmv

A

a.epstein barr

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18
Q

living in which regions increases risk of MS

a.high latitude
b.low latitude

A

a.high latitude

less UV exposure and less vitamin D

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19
Q

which of these is a modifiable risk factor for MS

a.smoking
b. alcohol
c. obesity

A

a.smoking

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20
Q

what is the most common subtype of MS

a.relapse remitting
b.secondary progressive
c.primary progressive

A

a.relapse remitting

85%

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21
Q

how long after onset does relapse remitting become secondary progressive

a.2 yrs
b.5 yrs
c.10 yrs

A

c.10 yrs

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22
Q

a steady increase in disability without attacks describes which type of MS

a.primary progressive
b.secondary progressive
c.relapsing remitting

A

a.primary progressive

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23
Q

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

A

b.secondary progressive

24
Q

no new disability between attacks describes which type of MS

a.primary progressive
b.secondary progressive
c.relapsing remitting

A

c.relapsing remitting

25
Q

how do MS lesions appear on MRI

a.dark
b.white

A

b.white

csf is bright white
pathological white fluid shows duller white

26
Q

in. a FLAIR MRI which signal is nullified

a.fat
b.csf

A

b.csf

normally bright white

27
Q

in a T1 MRI which tissue is bright

a.fat
b.csf
c.csf and fat

A

a.fat

T1- 1 tissue bright

28
Q

in a T2 which tissue is bright

a.fat
b.csf
c.csf and fat

A

c.csf and fat.

t2– 2 tissues are bright
ww2 - water is white

29
Q

what signal is suppressed in. STIR MRI

a.fat
b. csf

A

a.fat

30
Q

in a gadolinium enhanced MRI what is enhanced

a.fat
b.csf
d.vasculature

A

d.vasculature

31
Q

vascular mimics of MS

A

small vessels disease
CNS vasculitis
CADASIL

32
Q

autoimmune MS mimics

A

acute disseminated encephalomyelitis
neuromyleitis optica
SLE
neurosarcoidosis

33
Q

infectious mimics of MS

A

neurosyphilis
HIV
Lyme disease

34
Q

neuroplastic mimics of MS

A

primary brain tumour
glioblastis cerebri
CNS lymphoma

35
Q

genetic mimics of MI

A

mitochondrial disease
adrenoleucodystrophy
hereditary spastic parapesis

36
Q

tests to exclude alternative diagnoses before referring to a neurologist

A

fbc
crp
lft
rat
calcium
glucose
thyroid glucose
b12
HIV

37
Q

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

A

c. look for evidence of inflammation

38
Q

presence of what in csf may indicated ms

A

a.oligoclonal bands

also look t wbc and proteins

39
Q

wha test demonstrates a delay in signal transmission along the optic nerve

a. MRI
b. eeg
c.emg
d. VER

A

d. VER

visual evoked response

40
Q

the risk of ms after CIS (clinically isolated syndrome) is calculated based on what..

A

MRI lesion load

presence of CSF oligoclonal bands

41
Q

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

A

d.relapse

confirmed with new or worsened neurological dysfunction

42
Q

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

a.infection

43
Q

what drugs can be used to speed up recovery in some relapses

a. steroids
b.beta blockers
c.DMARDs
d.SSRIs

A

a. steroids

44
Q

which part of the nerve is attacked in MS

a.myelin sheath
b.dendrites
c.external lamina
d.schwann cells

A

a.myelin sheath

45
Q

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

a.inflammation, demyelination, remyelination to less inflammation , more axonal loss

46
Q

what is the purpose of treatment in MS

a. curative
b.disease modifying

A

b.disease modifying

act on immune system to reduce inflam and demyelination
reduce relapse rate
may improve long term disability

47
Q

in clinically isolated syndromes what is the purpose of DMT

A

can delay time until 2nd relapse
decreased brain atrophy rate

48
Q

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

a.moderate efficacy - interferon beta, glatiramer acetate, teriflunomide

49
Q

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

A

b.high efficacy - natilizumab, alemtuzumab

50
Q

what drug is given in active secondary progressive MS

a. interferon beta
b.ocrelizumab
c. siponimod
d. natilizumab

A

c. siponimod

51
Q

what drug is used to treat active primary progressive MS

a. interferon beta
b.ocrelizumab
c. siponimod
d. natilizumab

A

b.ocrelizumab

52
Q

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

a.gabapentin

53
Q

which drug is used for spacisitiy in ms

a.gabapentin
b.ocrelizumab
c.siponimod
d.baclofen
e.anti cholinergic
d.anxiolytics

A

d.baclofen

54
Q

which drug is used for bladder overactivity in ms

a.gabapentin
b.ocrelizumab
c.siponimod
d.baclofen
e.anti cholinergic
d.anxiolytics

A

e.anti cholinergic

55
Q

which drug is used for mood disorder in ms

a.gabapentin
b.ocrelizumab
c.siponimod
d.baclofen
e.anti cholinergic
d.anxiolytics

A

d.anxiolytics

neurology 1 (44 decks)

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