MS

Question 1

explain multiple sclerosis

Answer 1

progressive immune mediated disease of CNS that results in demyelination, oligodendrocyte loss, and axon degeneration.

Question 2

explain gliosis

Answer 2

result from proliferation/damage of neuro tissue w/i CNS that results in glial scars seen on MRI

Question 3

white matter is affected early in disease with damage to ____ and grey matter is effected later in the disease causing damage to ____ and ____

Answer 3

axons; cell bodies + dendrites

Question 4

explain the “outside-in model” theory of MS

Answer 4

immune cells circulating enter the BBB and attack oligodendrocytes/myelin

Question 5

explain the “Inside-out model” theory of MS

Answer 5

Damage to brain/oligodendrocytes triggers immune cells that pass thru BBB and cause further damage

Question 6

as MS progressess, demyelinated areas get filled with ____ and form plaques

Answer 6

astrocytes

Question 7

4 main areas that MS damage occurs

Answer 7

Optic N
periventricular white matter
spinal cord
cerebellar peduncles

Question 8

Loss of temporary vision, dull ache behind eye, and blurry vision indicate

Answer 8

optic neuritis

Question 9

explain dissemination in space and time

Answer 9

dissemination in space:
- lesions in multiple areas on 1 MRI

dissemination in time
- lesions seen in MRI after original scan where they were not previously seen

Question 10

CSF fluid is tested for what that indicates MS?

Answer 10

elevated IGg
found in 90-95% of pts

Question 11

difference between benign and malignant MS

Answer 11

benign: full function 15yrs after initial diagnosis (better prognosis)

Malignant: rapid onset + progression w. death within few years

Question 12

this subtype of MS indicates active or not active MS with 1st episode of inflamm/demyelination in CNS that could become MS

Answer 12

Clinically isolated Syndrome (CIS)

Question 13

this is the most common MS subtype and pt presents w. discrete attacks followed by no sign of disease progression and complete return to function

Answer 13

Relapsing Remitting MS (RRMS)

Question 14

this subtype of MS presents as near continuous decline with function progressively worsening w.o distinct attacks

Answer 14

primary progressive MS
(PPMS)

Question 15

this subtype of MS starts w. RRMS followed by consistent progression as disease advances with irreversible decline in fucntion

Answer 15

SPMS: secondary progressive MS

Question 16

Can full remission occur in SPMS?

Answer 16

Nope

Question 17

exacerbation or relapse lasts ____

Answer 17

> 24hrs

Question 18

what 3 things are factors that can cause exacerbation?

Answer 18

viral/bacterial infx, asthma attack or other disease
heat
stress

Question 19

Pseudo exacerbation is the temporary worsening of symptoms that last ____

Answer 19

<24hrs

Question 20

what is Uthoff’s symptom and what causes it?

Answer 20

adverse reaction to heat that resolves w. cooling
caused by excessive external heat, fever, or prolonged exercise

Question 21

what type of sensory changes occur in pts with MS? (3)

Answer 21

intense sharp pain and numbness and chrnoic pain (~80%)
tic douloreux (trigeminal neuralgia)
vision changes

Question 22

whats lhermitte’s sign?

Answer 22

electric shock like sensation during flexion of head

Question 23

what type of vision changes can patient experience?
5

Answer 23

optic neuritis
scotoma
marcus Gunn Pupil
nystagmus
diplopia

Question 24

marcus Gunn Pupil

Answer 24

shine light in eye and both eyes dilute

Question 25

what is the biggest issue that 95% of pts experience on a daily basis that doesn't relate to severity of disease

Answer 25

fatigue

Question 26

name exacerbating risks that cause fatigue 5

Answer 26

mood (depression) spasticity exertion heat not enough sleep

Question 27

what are the 3 Ds pt experience if the cerebellum is involved

Answer 27

dysmetria dyssenergia dysdiadochokinesia

Question 28

pt with MS present can present with what kind of tremor?

Answer 28

intentional (mvmt) tremor

Question 29

fear of falling is associated w. self-imposed restriction in mobility leading to

Answer 29

inc disability/falls & social isolation

Question 30

T/F 50% of RRMS will req. AD w/in 15 years

Answer 30

T

Question 31

what are the for 3 Ds of speech that 40% of pt exibit?

Answer 31

dysphagia dysphonia dysarthria

Question 32

T/F ~80% of pts have issues with bowel, bladder, and sexual dysfunction

Answer 32

T

Question 33

life expectancy after diagnosis of MS?

Answer 33

25yrs

Question 34

what are the predictors of good prognosis of MS?

Answer 34

1. onset w. only 1 symptom 2. benign & RRMS 3. <40yo 4. neuro imaging at 5 years with few overall lesions

Question 35

T/F no medications can reverse existing deficits

Answer 35

T

Question 36

what are the 3 functions of meds?

Answer 36

1. management of acute relapse via corticosteroids 2. disease modifying agent via synthetic interferon 3. management of symptoms

Question 37

explain the 3 kinds of preventions primary, secondary, tertiary

Answer 37

Primary: prevent MS and HTN Secondary: meds to delay or for symptoms management Tertiary: minimize deg of of disability

Question 38

preventive & restorative techniques during early-moderate stage of MS

Answer 38

regular exercise to improve strength, ROM, balance Community classes to maintain social life + positive outlook

Question 39

compensatory strategies in middle-mod stage

Answer 39

AD to maintain function W/c for community ambulation

Question 40

In late to advanced stages of MS are pts able to live alone without any assistance?

Answer 40

no. they're unable to live alone, req full time assist, and are dependent w. most ADLs

Question 41

preventive interventions in late-advanced stages MS

Answer 41

maximize upright posture & out-of bed time while preventing contractures, pneumonia, & wounds

Question 42

compensatory strategies in late-advanced stages

Answer 42

family education on positioning , pressure relief devices + psych support

Question 43

T/F utilizing vibration with tuning fork aids in balance performance

Answer 43

T?

Question 44

what outcome measure do you use to assess fatigue in MS?

Answer 44

VAS for fatigue, fatigue scale for motor & cognitive functions (FSMC)

Question 45

20 question pt reported outcome Assess affects of cognitive and motor fatigue in their daily life 20-100 point scale

Answer 45

Fatigue scale for motor & cognitive functions (FSMC) ≥43 is mild fatigue ≥53 is moderate fatigue ≥63 as severe fatigue.

Question 46

(self-report impact of MS on walking ability) 12 diff questions about walking and if MS does not affect or extremely affects their ability helps keep track of MS and what exactly is causing issues

Answer 46

12-item MS Walking Scale Higher scores indicate a greater impact on walking than lower scores. out of 60points and turned to percentage

Question 47

Self reported measure (emotional, cog, function) asks how they feel compared to ~4wks ago, whats bothering them the most which helps determine if referral is needed

Answer 47

Multiple Sclerosis Quality Of Life—54 (MSQOL-54)

Question 48

what do you always have to keep in mind when treating an MS patient (environment)

Answer 48

keep in mind heat, temp to prevent overheating cause can cause exacerbation

Question 49

Pt's (should/should not) exercise during exacerbation

Answer 49

Should not, wait until remission

Question 50

T/F You should monitor fatigue, spasticity, balance, tremor, heat tolerance

Answer 50

T

Question 51

Eccentrics and BFRT should be utilized when working on?

Answer 51

gait

Question 52

what 2 orthotics would MS pts benefit from

Answer 52

articulating AFO to promote DF or posterior leaf AFO

Question 53

should MS pt do resistance training every day or on alternate days?

Answer 53

alternate to prevent fatigue/overwork

Question 54

do pts with MS have increased spasticity and decline in cog function?

Answer 54

yes

Question 55

when do pts with MS present w. autonomic dysfunction?

Answer 55

advanced stages