MS

Question 1

MS triad

GID

Answer 1

NEURONAL LOSS by-

Inflammation

Demyelination

Gliosis

Question 2

MOA Antigen MS

Answer 2

MBP (Myelin basic protein)—T cells—BBB disruption—B cells against CNS (AXONS ARE NOT AFFECTED)— Destruction

Question 3

C/F MS

SOWDAA

Answer 3

SENSORY (Paresthesia-mc / Dysthesia / Hypoesthsia)

OP NEURITIS (VA / Color / Peri orb pain increasing w movement / Papillitis f/b optic atrophy / pupillary defect)

WEAKNESS (Exercise induced / Spasticity+ / Urge incontinence +)

DIPLOPIA (MLF lesion—INO—Wall Eyed b/l opthalmoplegia)

ATAXIA (dt cerebellar lesions)

ANCILLARY (Uthoff / Lhermitte)

Question 4

Uthoff and Lhermitte signs

Answer 4

Brief duration / 10-20s / 1-40 times a day

U= Loss of vision with increase in temperature

L= Flex neck— shock in spine radiating to LL

Question 5

Order of symptoms in MS

Answer 5

Sensory—-> WEAKNESS——> ON

Question 6

MC symptom of MS

Answer 6

Weakness»>sensory/ON»»ATAXIA

Question 7

Types of MS

Answer 7

RRMS (Relapse & Remit)—mc

PPMS (Primary Progressive)

SPMS (Secondary Progressive)

BOMA (Bout onset)

Question 8

Features of RRMS

Answer 8

F>M

20-40y

A/w——— VIT D DEFICIENCY**
EBV***

Question 9

Features PPMS

Answer 9

F=M

Onset > 40

WORST PROGNOSIS (Disability fast)

Question 10

Gene a/w Ms?

Answer 10

HLA DRB1 (~RA)

Question 11

Scoring for MS

1-10

Answer 11

EDSS SCALE (Extended Disability Scoring Scale)

1-2= normal 
2-4= Impairment/paresis
4-5.5= Ambulatory
6= cane
7 = Wheel chair
8 = bed bound

Question 12

Ix for MS

MCA

Answer 12

MRI

Csf analysis

Agarose gel electrophoresis

Question 13

MRI features of MS

Answer 13

+ in 95% patients

DEMYELINATION/ PLAQUES (JIPS)

• Juxtacortical
• Periventricular
• Infratentorial
• Spinal Cord

Question 14

CSFA MS

Answer 14

NO PLEOCYTOSIS
(If cells > 75— r/o)

Mild protein increase
(If >100–r/o)

IgG INCREASE**

Question 15

Agarose gel electrophoresis finding

Answer 15

OCB > 2 (Oligoclonal bands)
- +ve in 75% patients***

ABSENT AT ONSET—increases with time

Question 16

Diagnostic criteria of MS name

Answer 16

McDonald’s criteria

Question 17

DOC acute attack of Ms

Answer 17

Ch3pred IV———-fail?

—-PLASMAPHEREIS—-fail?

——Disease Modifiers

Question 18

Disease modifiers in MS

Doc RRMS

Answer 18

Highly effective (NAMO)- NATALI / ALEMTU / MITOXANTRONE / OCRELIZUMAB

Mod effective- Fingolimod / Fumarate

Modestly effective- Inf B (DOC) / GLATIRAMER / Teriflunomide

Question 19

DOC PPMS

Answer 19

Ocrelizumab

Question 20

DOC SPMS

Answer 20

Inf-B HIGH DOSE

For active cases

Question 21

ACUTE MS NAME

Answer 21

MARBURG VARIANT

Question 22

Marburg features

Answer 22

Fulminant demyelinating disease

No remission

Death in 2 years

Idiopathic

Question 23

Good prognostic features for MS

Answer 23

ON / Sensory symp at ONSET **

< 2 relapses in a year

Minimal impairment at 5 years

Question 24

Poor px factors for MS

Answer 24

Truncal ATAXIA

Pyramidal symptoms

Question 25

What is DEVIC DISEASE

Answer 25

Neuromyelitis Optica

Question 26

Age and sex for NMO

Answer 26

F»M

Childhood

Question 27

C/f of NMO

Answer 27

B/L** ON

Myelitis- (Severe/ transverse inv >3 seg / Recurrent but non progressive)

Hypothalamic lesions- Endocrinopathies+

Area prostrema+ (Vomiting + hiccups)

AQP4 Ab (BBB disruption—astrocytopat)

AQP4 damage occurs in kidney also but it has AQP3 on its internal lumen of CD —-compensation

aQP2 = outer side of lumen

Aqp1 = pct

Question 28

Ix NMO

Answer 28

CSF= pleocytosis ++++

AGE= OCB -

Question 29

Organisms aw NMO

Answer 29

HIV

EBV

VZV

Question 30

AIDs aw NMO

Answer 30

SLE

Sjogrens

MG

Hashimoto

Question 31

Rx NMO

Answer 31

Ch3 pred—-plasmapheresis

Question 32

Prophylaxis NMO

Answer 32

MFM
Rituximab
Azathioprine

MS DMA NOT EFFECTIVE IN NMO