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Neurology > ILO MS Week > Flashcards

ILO MS Week Flashcards

1
Q

What is MS?

A

It is thought to be an autoimmune disease that results in inflammation and demyelination of the CNS

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2
Q

What specific cells are thought to play a key role in effector and regulation in MS?

A

CD4+ cells

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3
Q

When is the most common time for MS symptoms to start and the patient be diagnosed?

A

Between 20 and 50

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4
Q

Are men or women at higher risk of MS?

A

Women

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5
Q

Are you at higher risk of MS living closer or further away from the equator?

A

Further away

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6
Q

What is the commonest early symptoms on MS?

A

Visual disturbances such as double vision

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6
Q

Name some common presenting complaints for MS

A

Muscle weakness, blurred vision, tremors and numbness in limbs

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6
Q

What are the 4 types of MS?

A
  • Relapsing - remitting MS
  • Secondary progressive MS
  • Primary progressive MS
  • Progressive relapsing MS
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7
Q

What is the most common type of MS?

A

Relapsing- remitting MS

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8
Q

What does relapsing-remitting MS usually turn into?

A

Secondary progressive MS

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9
Q

How long does it usually take for a patient to go from relapsing-remitting MS to secondary progressive MS?

A

15 years

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10
Q

Name the two main ways in which we can diagnose MS clinically?

A

CT head and a lumbar puncture

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11
Q

Name some conditions that can be diagnosed with the aid of a lumbar puncture

A

Meningitis, MS, Guillian Barre syndrome and TB

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12
Q

What is the normal limit for RBCs and WBCs in a CSF sample from a lumbar puncture?

A

Up to 5

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13
Q

In a normal lumbar puncture, if you were looking at the WBC count what would you expect to see?

A

Lymphocytes should be in the highest proportion, followed by polymorphonuclear leukocytes (PMNs)

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14
Q

What is the biggest indicator on a LP that the patient may be suffering from MS?

A

If electrophoesis shows the presence of oligoclonal bodies

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15
Q

If a patient has MS will their protein levels in CSF from an LP be high or low?

A

High

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16
Q

If a patient has Guillian Barre syndrome what reaidng will be significantly raised in the CSF from a LP?

A

The protein

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17
Q

What is the biggest symptoms of Guillian Barre Syndrome?

A

Progressive ascending weakness that is very rapid

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18
Q

What type of meningitis will give you a cloudy/turbid CSF?

A

Bacterial meningitis

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19
Q

What type WBCs are seen in high counts if the patient has bacterial meningitis?

A

PMNs

20
Q

What type WBCs are seen in high counts if the patient has viral meningitis?

A

Lymphocytes

21
Q

If the patient has a low glucose level in the CSF what type of meningitis should you think of?

A

Bacterial

22
Q

In meningitis will protein levels in CSF be normal or elevated?

A

Elevated

23
Q

What type of meningitis is the most common?

A

Viral

24
Q

What type of meningitis has the highest mortality rate?

A

Bacterial

25
Q

What are the 3 types of meningitis?

A

Bacterial, viral and fungal

26
Q

Do central or peripheral nerves regenerate rapidly?

A

Peripheral

27
Q

Where do central nerves become peripheral nerves?

A

Forman transversarium

28
Q

What are the two main ways in which a nerve can become injured? And what is the better injury?

A

Crushed or severed
(crushed it better)

29
Q

What is a neurological weakness that is classed as a medical emergency?

A

Cauda Equina Syndrome

30
Q

Name some symptoms of Cauda Equina Syndrome?

A
  • Saddle or genital sensory loss
  • Bladder, bowel and sexual dysfunction
  • Severe lower back pain, like a sciatica pain
31
Q

If you patient has very bad back pain what are your first line treatments to help them?

A

NSAIDs, keeping active, physio and maybe even weak opioids in severe cases

32
Q

What condition is most common when considering anterior ventral horn cell damage?

A

Motor neurone disease

33
Q

What is the most common first presentation of MND?

A

Asymmetric limb weakness

34
Q

In MND do patients lose both their sensory and motor neurones?

A

No, they only lose their motor neurones, they can still feel all of their limbs

35
Q

What is the pathology when a patient has Myasthenia Gravis?

A

They have a problem at NMJ. It is an autoimmune condition that means the patient makes too much ACh and the ACh receptors at the NMJ become saturated and the muscle can no longer contract

36
Q

What can we use to treat myasthenia gravis?

A

Drugs that prolong the binding time of ACh, to increase the chance that it binds to cause muscle contraction

37
Q

Name some ways you may develop a brachial plexus injury

A

Falling out of a tree, falling on your neck, during child birth

38
Q

What is the most commonly seen lumbosacral plexus injury?

A

Carpel tunnel syndrome?

39
Q

What are the main treatments that we have for MS?

A

Corticosteroids, and Disease modfiying therapies (DMT)

40
Q

If a patient is experiencing an MS flare up/relapse what should you prescribe?

A

0.5g of oral methylprednisolone for 5 days OR
1g of IV methylprednisolone for 3 days.

41
Q

What are the 3 ways that DMT can be administered in MS?

A

Orally, IV and injectables (IM mainly)

42
Q

What is the most commonly used injectable DMT used in MS?

A

Beta interferons (Avenox)

43
Q

What is the oral DMT that we prescribe for patients with MS?

A

Dimethyl fumerate (Tecfidera)

44
Q

What are the 2 monoclonal antibody treatments used in MS?

A

Natalizumab and Alemtuzumab

45
Q

How often do patients need to take natalizumab?

A

Monthly infusions

46
Q

How often do patients need to take Alemtuzumab

A

Short courses of intense therapy

47
Q

What MAB therapy used in MS has a reversal drug?

A

Natalizumab

48
Q

What MAB therapy used in MS is associated with common infusion reactions?

A

Alemtuzumab

Neurology (2 decks)

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