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Neurology > MS > Flashcards

MS Flashcards

1
Q

MS is particular to the CNS or the PNS?

A

CNS so oligodendrocyte

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2
Q

Comment on the prevalence of MS in relation to the equator

A

Further north or further south of equator you go, prevalence is higher

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3
Q

First degree relative with MS, what is risk?

A

3-5%

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4
Q

Identical twin with MS, chance of developing?

A

1/3

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5
Q

Factors contributing to MS? (3)

A

Genetics, environment immune response

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6
Q

85-90% patients will have what type of MS?

A

Relapsing remitting MS (RRMS)

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7
Q

20-50% of RRMS develop what?

A

Secondary progressive MS (SPMS)

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8
Q

10-15% of patients with MS is what type?

A

Primary Progressive MS (PPMS)

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9
Q

What is multiple sclerosis and what is the name of its lesions?

A

Inflammatory demyelinating disorder of the CNS, plaques

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10
Q

Female:Male ratio of MS

A

3:1 F:M

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11
Q

In what age group do most MS patients initially present?

A

30s and 40s

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12
Q

List 6 possible clinical features of MS

A 
Pyramidal dysfunction, 
Optic neuritis, 
Sensory symptoms
Lower urinary tract dysfunction,
Cerebellar and brain stem features,
Cognitive impairment
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13
Q

List 3 symptoms of pyramidal dysfunction

A

Increased tone, (velocity dependent)
Spasticity,
Weakness in pyramidal distrubiton

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14
Q

What is weakness in pyramidal distribution?

A

Weakness in extensors of upper limbs and flexors of lower limbs

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15
Q

Approx 40% of patients with MS present with optic neuritis. Basic presentation of optic neuritis?

A

Painful visual loss over 1-2 weeks. May present with RAPD

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16
Q

List 5 sensory symptoms of MS

A 
Pain, 
Paraesthesia, 
Dorsal column loss, 
Numbness, 
Trigeminal neuralgia (very common in MS)
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17
Q

List 7 symptoms of cerebellar dysfunction

A 
Dysarthria,
Ataxia,
Nystagmus,
Intention tremor, 
Past pointing, 
Pendular reflexes, 
Dysdiadokinesis
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18
Q

MS patients with ataxia from cerebellar dysfunction tend to veer towards the contralateral side of lesion. True/false?

A

False - veer towards same side as lesion

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19
Q

Brain stem dysfunction depends on where lesion is. A lesion of R brainstem could cause both R VI palsy and R VII palsy, how would this present?

A

Diplopia

Facial weakness

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20
Q

A plaque on the medial longitudinal fasciculus would cause what? What are the symptoms (4)?

A

Internuclear opthalmoplegia.

Symptoms: distortion of binocular vision, failre of adduction (diplopia), nystagmus in abducting eye, lag

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21
Q

What is an additional very common MS symptom?

A

Fatigue

22
Q

Lower urinary tract dysfunction in MS can present as frequency, nocturia, urgency, urge incontinence and retention. What 2 problems cause this?

A

Increased tone of bladder neck and irritability of detrusor muscle

23
Q

MS investigations (4)

A

Blood tests, MRI, CSF, neurophysiology (e.g. EEG)

24
Q

List 6 DD for MS symptoms

A 
Vasculitis, 
Granulomatous disorder, 
Vascular disease,
Structural lesion, 
Infection, 
Metabolic disorder e.g. B12 and folate deficiency
25
Q

List specific blood tests for MS to rule out other diseases

A 
PV, FBC, CRP, 
Renal liver bone profile, 
Auto antibody screen, 
Borellia, HIV, syphilis serology, 
B12 and folate, 
Vit D
26
Q

Borellia is the bacteria that causes what disease that can mimic MS?

A

Lyme disease

27
Q

PV, FBC and CRP bloods are done to check for inflammation caused by other inflammatory diseases and not MS. True/false?

A

True

28
Q

List 2 sequences of MRI for identifying MS

A

T2 + FLAIR

29
Q

What is needed for MS diagnosis?

A

Clinical episode, dissemination in time and place, exclusion of other causes

30
Q

Oligoclonal bands tend to be present in most MS patients CSF. What is abnormal result?

A

Unmatched oligoclonal bands in CSF. Unmatched means there aren’t the same ones in the serum

31
Q

Acute relapse treatment for mild, moderate and severe

A

Mild: symptomatic treatment,
Moderate: high dose oral steroids,
Severe: admit/IV steroids

32
Q

List 4 treatments for spasticity

A

Physio,
Antispasmodics
Botulinum toxin,
Intrathecal baclofen

33
Q

Give 2 examples of antispasmodics used in MS

A

Baclofen,

Tizanidine

34
Q

List 5 treatments for sensory symptoms of MS

A 
Anticonvulsant e.g. gabapentin, 
Antidepressant e.g. amitriptyline, 
Tens machine, 
Acupuncture, 
Lignocaine infusion
35
Q

List 4 treatments for lower urinary tract dysfunction in MS

A

Bladder drill,
Anticholinergics e.g. oxybutynin,
Desmopressin,
Catheterisation

36
Q

Occupation health nurses, amantadine & modafinil (less), hyperbaric oxygen are all treatment for what symptoms of MS?

A

Fatigue

37
Q

What is cannibas licensed for?

A

Resistant spasticity

38
Q

Efficacy of MS treatment depends on when treatment is given - true/false?

A

True

39
Q

What is first line disease modifying therapy for MS? Which is injectable?

A

Tecfedira/aubagio (tablets), interferon beta (injectable), glitiramer acetate (injectable)

40
Q

What is second line disease modifying therapy for MS?

A

Monoclonal antibody e.g. tysabri, ocrevus, lemtrada,

Fingolimod

41
Q

What is third line disease modifying therapy for MS?

A

Mitoxantrone (less as toxic to heart), HSCT (stem cell transplantation)

42
Q

1st line DMARD used when?

A

Relapse onset MS

43
Q

When is second line disease modifying therapy licensed for use in MS? (2)

A

If tried first line or have very aggressive MS

44
Q

FBC and liver function monitoring must be done every _ months for patients on tecfedira?

A

3 months

45
Q

Interferons and glitiramer acetate decrease relapse rate by how much? They decrease severity of relapses by how much?

A

Decrease relapse rate by 1/3 and decrease severity of relapses by 50%

46
Q

What is first line tablet for RRMS? What is approximate relapse rate?

A

Tecfidera - 44% reduction in relapse rate

47
Q

Second line tablets for MS are? What is reduction in relapse rate?

A

Fingolimod/cadrabine, >50% reduction in relapse rate

48
Q

Monoclonal antibody ocrelizumab targets what site?

A

Anti CD 20

49
Q

Monoclonal antibody alemtuzemab targets what site?

A

Anti CD50

50
Q

Monoclonal antibody natilizumab targets what site?

A

Anti integrin

51
Q

Monoclonal antibodies are licensed when?

A

In highly active RRMS e.g. patient with rapidly evolving severe RRMS or patients who already tried interferon/glitiramer acetate

52
Q

Which is best treatment but worst side effect?

A

Monoclonal antibodies

Neurology (34 decks)

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