MS

Question 1

MS is a chronic progressive autoimmune diseased characterized by ___________________.

Answer 1

inflammation
selective demyelination
gliosis

Question 2

What age is typical onset for MS?

Answer 2

20-40 years

Question 3

What is the cause of MS?

Answer 3

unknown

could be related to viral infections

Question 4

How is MS diagnosed?

Answer 4

a lumbar puncture is performed and pt has IgG and oligoclonal bands in CSF

Question 5

MS is predominantly a T cell disorder with over production of ______________.

Answer 5

Pro inflammatory cytokines

Question 6

What is the pathogenesis of the initial event for MS?

Answer 6

peripheral T cells are activated
T cells cross the blood brain barrier
T cells secrete cytokines that recruit inflammatory cells and induce antibody production
anti myelin antibodies and other factors work together and result in demyelination

Question 7

What is the pathogenesis of inflammation regarding MS?

Answer 7

excessive amounts of glutamate released
glutamate causes increase influx of calcium
calcium results in toxic damage to oligodendrocytes and axons

in early stages myelin can be reproduced, but eventually it will become incomplete and then stop all together

Question 8

The demyelinated area becomes filled with _______________ and undergoes _________.

Answer 8

fibrous astrocytes
gliosis

Question 9

What is gliosis?

Answer 9

proliferation of neuro-glial cells within the CNS that result in glial scars

Question 10

What is the word for glial scars?

Answer 10

plaques

Question 11

Why are plaques bad?

Answer 11

they disrupt axon conduction and cause the axons to degenerate over time

Question 12

What is the main cause of long term disability in MS?

Answer 12

gliosis and the formation of plaques

Question 13

What sites does demyelination have an affinity for?

Answer 13

optic nerve
periventricular white matter
corticospinal tracts
posterior column of SC

Question 14

What is the common early sign for MS?

Answer 14

double vision

Question 15

Where might an acute plaque (new) show up?

Answer 15

site of previous legion or at edges

Question 16

Demyelinated plques undergo slow ________________.

Answer 16

Wallerian Degeneration

Question 17

Permanent damage happens ________________.

Answer 17

distal to proximal

Question 18

What are the classifications of MS?

Answer 18

Relapsing remitting
primary progressive
secondary progressive
progressive relapsing

Question 19

What is the hallmark of the relapsing remitting stage?

Answer 19

stable course between relapses

Question 20

How frequent are exacerbations in relapsing remitting MS?

Answer 20

1 every 2 years

Question 21

How long can a pt stay in the relaxing remitting stage of MS?

Answer 21

5-15 years

Question 22

Secondary progressive MS usually begins as ______________.

Answer 22

relaxing remitting

Question 23

How is secondary progressive MS different from relapsing remitting?

Answer 23

there is a change in the disease progression to steady and irreversible decline with or without exacerbations

Question 24

What is primary progressive MS?

Answer 24

slow continuous decline in function with no distinct exacerbations

rare

Question 25

What is progressive relapsing MS?

Answer 25

progressive disease from onset with clear relapses, but continued disease progression **very rare**

Question 26

What form of MS is associated with later onset (40 yo) and predominantly SC symptoms?

Answer 26

primary progressive

Question 27

What is an exacerbation?

Answer 27

new and recurrent symptoms lasting more than 24 hours

Question 28

What are factors that may precede an exacerbation?

Answer 28

medical conditions overall health stress immune stress heat

Question 29

What are common first symptoms of MS?

Answer 29

optic neuritis extremity numbness weakness

Question 30

What are other symptoms of MS?

Answer 30

fatigue impaired coordination, balance, gait spasticity pain

Question 31

What do acute and chronic lesions look like on an MRI?

Answer 31

acute- bright spots chronic - dark spots

Question 32

What is McDonald MS Diagnosis Criteria?

Answer 32

2 or more attacks and 2 or more lesions present heavily MRI dependent

Question 33

What are the 3 categories of drugs for MS?

Answer 33

disease modifying agents immunosuppressors recently approved

Question 34

What does interferon B do?

Answer 34

decreases the production of proinflammatory cytokines Received as injection every other day

Question 35

What are side effects of interferon B?

Answer 35

local reaction from injection flu-like symptoms liver and thyroid dysfunction mood disorders

Question 36

What are potential complications that reduce life expectancy?

Answer 36

pneumonia UTI skin breakdown

Question 37

What are negative prognostic indicators for MS?

Answer 37

motor and CB symptoms disability after first attack short interval between attacks numerous relapsing in first year

Question 38

What are positive prognostic indicators?

Answer 38

infrequent attacks full recovery after relapse low level disability after 5-7 years