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Pathophysiology > MS > Flashcards

MS Flashcards

1
Q

MS is a chronic progressive autoimmune diseased characterized by ___________________.

A

inflammation
selective demyelination
gliosis

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2
Q

What age is typical onset for MS?

A

20-40 years

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3
Q

What is the cause of MS?

A

unknown

could be related to viral infections

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4
Q

How is MS diagnosed?

A

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

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5
Q

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

A

Pro inflammatory cytokines

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6
Q

What is the pathogenesis of the initial event for MS?

A

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

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7
Q

What is the pathogenesis of inflammation regarding MS?

A

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

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8
Q

The demyelinated area becomes filled with _______________ and undergoes _________.

A

fibrous astrocytes
gliosis

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9
Q

What is gliosis?

A

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

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10
Q

What is the word for glial scars?

A

plaques

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11
Q

Why are plaques bad?

A

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

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12
Q

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

A

gliosis and the formation of plaques

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13
Q

What sites does demyelination have an affinity for?

A

optic nerve
periventricular white matter
corticospinal tracts
posterior column of SC

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14
Q

What is the common early sign for MS?

A

double vision

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15
Q

Where might an acute plaque (new) show up?

A

site of previous legion or at edges

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16
Q

Demyelinated plques undergo slow ________________.

A

Wallerian Degeneration

17
Q

Permanent damage happens ________________.

A

distal to proximal

18
Q

What are the classifications of MS?

A

Relapsing remitting
primary progressive
secondary progressive
progressive relapsing

19
Q

What is the hallmark of the relapsing remitting stage?

A

stable course between relapses

20
Q

How frequent are exacerbations in relapsing remitting MS?

A

1 every 2 years

21
Q

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

A

5-15 years

22
Q

Secondary progressive MS usually begins as ______________.

A

relaxing remitting

23
Q

How is secondary progressive MS different from relapsing remitting?

A

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

24
Q

What is primary progressive MS?

A

slow continuous decline in function with no distinct exacerbations

rare

25
Q

What is progressive relapsing MS?

A

progressive disease from onset with clear relapses, but continued disease progression

very rare

26
Q

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

A

primary progressive

27
Q

What is an exacerbation?

A

new and recurrent symptoms lasting more than 24 hours

28
Q

What are factors that may precede an exacerbation?

A

medical conditions
overall health
stress
immune stress
heat

29
Q

What are common first symptoms of MS?

A

optic neuritis
extremity numbness
weakness

30
Q

What are other symptoms of MS?

A

fatigue
impaired coordination, balance, gait
spasticity
pain

31
Q

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

A

acute- bright spots
chronic - dark spots

32
Q

What is McDonald MS Diagnosis Criteria?

A

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

33
Q

What are the 3 categories of drugs for MS?

A

disease modifying agents
immunosuppressors
recently approved

34
Q

What does interferon B do?

A

decreases the production of proinflammatory cytokines

Received as injection every other day

35
Q

What are side effects of interferon B?

A

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

36
Q

What are potential complications that reduce life expectancy?

A

pneumonia
UTI
skin breakdown

37
Q

What are negative prognostic indicators for MS?

A

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

38
Q

What are positive prognostic indicators?

A

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

Pathophysiology (10 decks)

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