DemyelinatingDs_PretestStepup

Question 1

What is the classic location demyelination plaques of MULTIPLE SCLEROSIS?

Answer 1

ANGLES OF LATERAL VENTRICLES

Question 2

How do you make a CLINICALLY DEFINITE MS diagnosis?

Answer 2

1) 2 Sx episode

2) Evidence of 2 white matter lesions (Imaging or clinical)

Question 3

How do you make a LAB-SUPPORTED DEFINITE MS diagnosis?

Answer 3

1) 2 Sx episodes

2) Evidence of 1 white matter lesion (MRI) + Abnormal CSF oligoclonal bands

Question 4

What constitutes a PROBABLE MS diagnosis?

Answer 4

1) 2 Sx episodes

2) 1 white matter lesion OR CSF oligoclonal bands

Question 5

What is the most common initial presentation of MS?

Answer 5

Transient sensory deficits - DECREASED Sensation or parasthesia of UL/LL

Question 6

What is the most common initial visual disturbance of MS? Which visual disturbance strongly supports the diagnosis of MS?

Answer 6

INITIAL = OPTIC NEURITIS - Central scotoma, pain on eye movement, decreased PERLL, monocular vision loss

STRONGLY SUPPORTIVE = INO

Question 7

Describe a RIGHT Intranuclear ophthalamoplegia.

Answer 7

Right INO = Right MLF lesion = Inability to do LEFTWARD GAZE by RIGHT eye (R. CN III-mediated medial rectus/R.MLF involvement) + LEFT NYSTAGMUS (L. CN VI intact but brain is confused and saccades)

Question 8

How long do MS relapses generally occur for? How many times do relapses occur? What is the general age group affected for an initial MS presentation?

Answer 8

RELAPSE Sx >24hrs
Average 1/yr
20-30s

Question 9

What are risk factors of SEVERE DISABILITY of MS?

Answer 9

1) FREQUENT attacks early on
2) Onset at OLDER age
3) PROGRESSIVE course
4) Early PYRAMIDAL/CEREBELLAR involvement

Question 10

What is the MOST SENSITIVE test for diagnosing MULTIPLE SCLEROSIS?

Answer 10

MRI

Question 11

True or False: Number of demyelinated lesions on MRI correlates proportionally to disease severity/progression speed.

Answer 11

FALSE

Do NOT directly correlate

Question 12

What are useful diagnostic tests for MS? (3)

Answer 12

1) MRI - Demyelinated lesions in 90% of MS pts
2) CSF - Oligoclonal IgG bands in 90% of MS pts
3) Nerve Conduction Study - Evoked potentials are abnormal (newly re-myelinated nerves conduct sensory impulses more SLOWLY) in 90% of MS pts

Question 13

What is the recommended Tx for ACUTE ATTACKS of MULTIPLE SCLEROSIS?

Answer 13

HIGH DOSE IV STEROIDS

Question 14

Can HIGH DOSE ORAL STEROIDS be used for ACUTE ATTACKS? Does Tx of acute exacerbations alter outcome or course of MS?

Answer 14

NO, high dose ORAL steroids does not have the same efficacy as IV steorids

NO, ACUTE TX does NOT result in any improvement of long-term course of MS

Question 15

What are the two primary goals of MS therapy?

Answer 15

GOAL 1: Reduce relapses - IFN therapy, cyclophosphamide

GOAL 2: Reduce symptoms of acute exacerbations - baclofen/dantrolene, carbamazepine/gabapentin

Question 16

When is the most ideal time for IFN therapy administration for MS?

Answer 16

EARLY in the course of disease before disability becomes irreversible

Question 17

When is the most ideal time for CYCLOPHOSPHAMIDE therapy administration for MS?

Answer 17

LATE - Reserved for rapidly progressive disease bec there are many toxic AE

Question 18

What are the pharmacological drugs to reduce Sx associated with acute exacerbations of MS?

Answer 18

1) Reduce muscle spasticity - BACLOFEN, DANTROLENE
2) Reduce neuropathic pain - CARBAMAZEPINE (trigeminal neuralgia), GABAPENTIN
3) Anti-depressant - If use is indicated

Question 19

What are the classic features of MS?

Answer 19

1) OPTIC NEURITIS
2) LHERMITTE’S SIGN - barber chair sign electrical sensation down the back
3) UHTHOFF’S PHENOMENON (Worsening Sx with INCREASED body temp)
4) MOTOR/SENSORY DEFICITS
5) BOWEL/BLADDER DYSFN

Question 20

How does TROCHLEAR N. PALSY present?

Answer 20

VERTICAL DIPLOPIA
Worsens - Eye looks down and towards nose (walking downstairs or reading)

Gets better - tilt head away and chin towards lesion

Question 21

How does a TRANSTENTORIAL HERNIATION OF UNCUS (parahippocampal gyrus) during HEAD TRAUMA present?

Answer 21

1) Compression of IPSILATERAL CN III: IPSILATERAL DOWN/OUT/MYDRIASIS
2) Compression of CONTRALATERAL CRUS CEREBRI against tentorial edge: IPSILATERAL HEMIPARESIS
3) Compression of IPSILATERAL PCA: CONTRALATERAL HOMONYMOUS HEMIANOPIA
4) Compression of RETICULAR FORMATION: Altered LOC, COMA

Question 22

What is the pathophys of TRIGEMINAL NEURALGIA?

Answer 22

Like MS, it is DEMYELINATION of TRIGEMINAL NERVE NUCLEUS OR NERVE ROOT