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Neuro 2 > MS > Flashcards

MS Flashcards

1
Q

What process occurs during MS? Where does it primarily occur?

A

gliosis - change in glial cells that results in scarring which leads to axonal interruption and degeneration

white matter > gray matter

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2
Q

average age of onset with MS. Which gender is more likely to have MS?

A

15-50 years
- most common cause of disability in young and middle-aged adults
- women > men (3:1)

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3
Q

How is MS diagnosed?

A
  • clinical presentation
  • MRI - need to see dissemination in time (changes in plaque over time)
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4
Q

What are the 4 areas that gliosis needs to show up in in order to diagnosis MS

A
  • periventricular
  • juxtacortical (within the hemisphere)
  • infratentorial (cerebrum)
  • spinal cord
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5
Q

What is clinically isolated syndrome (CIS)? How long does it last

A
  • 1st clinical episode of a disease but has yet to fulfill criteria of dissemination in time
  • can be monofocal or multifocal
  • lasts at least 24 hours
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6
Q

What 2 things occurring at the same time increase your chance of developing MS?

A

CIS + MRI findings

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7
Q

risk factors for conversion of CIS to MS

A
  • polysymptomatic presentation
  • > /= 2 T2 MRI lesions
  • Oligoclonal bands present in CSF, not in serum lumbar puncture
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8
Q

What are the 3 common areas where CIS occurs?

A
  • optic neuritis
  • brainstem
  • spinal cord
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9
Q

CIS signs of optic neuritis

A
  • unilateral reduced visual acuity
  • orbital pain particularly with eye movement
  • reduced color vision
  • afferent pupillary defect - shine light in eye and different pupil response
  • retrobulbar or mild disc swelling

Think unilateral presentation

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10
Q

CIS signs of brainstem

A
  • bilateral internuclear ophthalmoplegia
  • ataxia and gaze-evoked nystagmus
  • 6th nerve palsy
  • facial sensory loss
  • vertigo
  • ataxia
  • dysarthria

Think bilateral presentation

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11
Q

What is Lhermitte’s sign? When does this occur?

A

sharp pain that passes down posterior neck and into spine and extremities when patient flexes neck
- spinal cord CIS

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12
Q

CIS signs of spinal cord

A
  • incomplete transverse myelitis
    • Lhermitte’s sign
  • sphincter symptoms
  • asymmetric limb weakness
  • symptom progression between 4 hours and 21 days
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13
Q

motor impairments with MS tend to be _______________

A

asymmetrical

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14
Q

MS signs and symptoms

A
  • motor function
  • sensory function
  • visual deficits
  • cog function
  • poor tolerance for temp increases
  • pain and fatigue
  • sleep disorders
  • speech and swallow impairments
  • dizziness
  • bowel and bladder dysfunction
  • sexual dysfunction
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15
Q

MS signs and symptoms of visual deficits

A

optic neuritis

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16
Q

MS signs and symptoms of cog function

A
  • hallmark - slowed information processing speed
  • divided and sustained attention
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17
Q

What type of pain is common with MS

A
  • trigeminal neuralgia
  • paroxysmal limb pain - shooting pain in arms/legs
  • headache
  • chronic neuropathic pain
18
Q

What is Uhthoff symptom?

A

increase in neuro symptoms in response to heating conditions
- pseudo-exacerbation that is transient (goes away once out of heat)

19
Q

difference between MS exacerbations and pseudo-exacerbations

A

MS exacerbations last > 24 hours

pseudo-exacerbations last < 24 hours
- transient worsening of symptoms

20
Q

relapsing-remitting MS

A

See some neurological change, followed by a period of remission (may return to baseline), then see back and forth between relapse and remission

21
Q

secondary progressive MS

A

Start as relapsing remitting but have plateaued and little to no relapses

22
Q

primary-progressive MS

A

continuous worsening from initial onset w/o distinct relapses
- faster progression and worse prognosis

23
Q

treatment during acute exacerbation

A

immunosuppressant drugs to treat flare ups
- prednisone
- methylprednosolone
- Adrenocorticotropic hormone (ACTH)

24
Q

Copaxone - what does it do? dosage? side effects?

A
  • synthetic protein to mimic effects of myeline protein
  • daily subcutaneous injection
    side effects
  • flu like symptoms, N&V, joint pain, visual disturbances, weakness, edema in hands and feet
25
Q

Interferon drugs - what does it do? dosage? side effects?

A
  • slow progression of disease and decrease symptoms
  • daily, 3x/wk, or weekly intramuscular or subcutaneous injections
    side effects
  • flu like symptoms, depression, abdominal pain, injection site pain, leukopenia
26
Q

What are the 8 functional systems of the EDSS?

A
  • pyramidal (paresis)
  • cerebellar - ataxia
  • brainstem
  • sensory
  • bowel and bladder
  • visual
  • cerebral - mental status
  • other - any other neuro findings
27
Q

normal to mild EDSS score

A

0-3.5

28
Q

mild to moderate EDSS score

A

4-5.5

29
Q

moderate to severe EDSS score

A

6-7.5

30
Q

severe disability w/ restriction to bed or wheelchair EDSS score

A

8-9.5

31
Q

EDSS 0-3.5 functional limitations

A

fully ambulatory without aid
- ranging from no limitations to limited endurance, unsteadiness, and impaired info processing and memory

32
Q

EDSS 4-5.5 ambulation

A

ambulatory with aid and starts to impact daily function
- limited walking distance (20-200m), falls, inability to safely complete dual motor/cog tasks, require work/home adaptions/compensatory strategies, challenge with transfers

33
Q

EDSS 6-7.5 ambulation

A

can only ambulate short distances
- minA to total assist with transfers and bed mobility
- independent to total assist with seated/standing balance

34
Q

12-Item MS Walking Scale
- which EDSS level is it used on? Cutoff score?

A
  • only used for EDSS 0-7.5
  • cutoff score for fall risk >/= 75
35
Q

Fatigue Scale for Motor and Cognitive function
- what does it measure?

A

differentiate between motor and cognitive aspects of fatigue

36
Q

Modified Fatigue Impact Scale
- what does it measure?

A

fatigue impact on physical, cognitive, psychosocial functioning

37
Q

MS Impact Scale
- what does it measure?

A

physical and psychosocial difficulties related in MS in past 2 weeks

38
Q

What is the mean time before use of unilateral AD and what is the life expectancy of MS?

A
  • mean time before AD - 15-20 years
  • life expectancy - ~10 years less than age-matched peers
39
Q

What greatly increases the chance of the development of MS in 7-10 years after finding?

A

white matter lesions on MRI

40
Q

Appearance of a new lesion on T2 weighted MRI ____________ after initial clinical episode = poor prognosis

A

< 3 months

41
Q

What are some favorable prognostic factors with MRI findings?

A
  • low total lesion burden
  • low active lesion formation
  • negligible myelin or axon loss

Neuro 2 (19 decks)

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