CBL - MS Flashcards

1
Q

What are the signs of optic neuritis? [3]

A
  1. red desaturation
  2. relative afferent pupillary defect on one eye
  3. optic disc pallor on one eye implying optic atrophy
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2
Q

What is Hoffman’s sign? [2]

A
  1. upper motor neurone (UMN) sign
  2. parallels the extensor plantar sign in the lower limb
  3. +ve when there is flexion of the ipsilateral thumb after tapping the nail bed of the 3rd finger
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3
Q

What are the upper motor neurone (UMN) signs that can be seen in the limbs? [6]

A
  1. increased tone in a spastic pattern
  2. weakness
  3. hyper-reflexia
  4. clonus
  5. extensor plantars
  6. positive Hoffman’s sign
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4
Q

What parts of the nervous system does MS usually affect and what clinical signs would be present due to a defect in each of these areas? [4]

A
  1. optic nerve
    • optic neuritis
  2. brainstem
    • ataxia
    • swallowing problems
    • eye movement problems
  3. spinal cord
    • bladder problems
    • constipation
    • limb weakness
  4. white matter hemispheric regions
    • motor problems
    • sensory problems
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5
Q

What finding in the CSF would indicate MS? [1]

What other condition can this finding also be present in? [1]

A

presence of oligoclonal bands in CSF (but not in the blood)

can also indicate sarcoidosis

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6
Q

What is the difference between a diagnosis of MS and a diagnosis of clinically isolated syndrome? [2]

A
  1. MS is diagnosed when there are 2 neurological lesions which are disseminated in space and time
  2. Clinically isolated syndrome is diagnosed when there is a single presentation of optic neuritis with a normal MRI
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7
Q

What is VERS and what does it show? [2]

A
  1. visual evoked responses
  2. measures the speed at which impulses travel along the optic nerve
  3. if delayed, this indicates optic neuritis
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8
Q

The McDonald criteria for MS requires dissemination in space, with a lesion in at least 2 of what locations? [4]

A
  1. periventricular (around the ventricles)
  2. juxtacortical (at the grey:white matter junction)
  3. infratentorial (e.g. cerebellum)
  4. spinal cord
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9
Q

What are the disease modifying treatment options for relapsing remitting MS? [7]

A

First line treatments

  • Injectable treatments
    • beta interferons
    • glatiramer acetate
  • Oral treatments (immunosuppressants)
    • dimethyl fumerate
    • teriflunomide

Second line treatments

  • fingolimod (stronger oral agent)
  • atalizumab (monoclonal antibody)

Third line treatments

  • alemtuzumab (powerful monoclonal antibody) that essentially resets the immune system and can eliminate MS relapses
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10
Q

Dimethyl fumerate:

  1. mechanism of action? [2]
  2. side effects? [3]
A
  1. mechanism of action:
    • suppresses immune system
    • reduces lymphocyte counts
  2. side effects:
    • flushing
    • GI side effects
    • potentially serious infections
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11
Q

What are the treatment options for progressive MS? [3]

A

SYMPTOM CONTROL

  1. fatigue
    • if disease related, modafinil or amantadine may help
  2. urinary symptoms
    • storage dysfunction:
      • anti-cholinergic agents (oxybutynin)
      • botox
    • emptying dysfunction:
      • self-catheterisation
      • tamsulosin
  3. spasticity
    • physiotherapy
    • drugs include gabapentin, benzodiazepines etc.
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