MS

Question 1

MS is an autoimmune reaction against?

Answer 1

oligodendrocytes

Question 2

In MS, what do you get destruction of?

Answer 2

myelin

Question 3

are peripheral nerves affected?

Answer 3

no

Question 4

normally, macrophages cannot easily cross the BBB, but what do they express that allows them to adhere and cross the endothelium?

Answer 4

glycoprotein α4 β1

Question 5

show up on MRI as white blobs, roughly 2-10mm in size, and can occur anywhere in the CNS, although most commonly occur at the optic nerves, periventricular lesion, brainstem and cerebellar connections?

Answer 5

plaques

Question 6

what is the most common form of MS?

Answer 6

relapsing remitting (RR)

Question 7

what is uhtoffs phenomenon?

Answer 7

symptoms worse during increased heat - conduction slows with increased heat

Question 8

most common presenting symptom?

Answer 8

fatigue/lethargy

Question 9

what is lhermittes sign?

Answer 9

on flexion of the neck, there is an electric shock sensation down the spine and into the limbs

Question 10

what are upper motor neurone signs?

Answer 10

spasticity, weakness, brisk reflexes

Question 11

what do oligoclonal bands show?

Answer 11

there is lots of antibody to something in the CSF - there will be oligoclonal bands in 80% of cases

Question 12

for diagnosis, you need at least 1 attack and multiple plaques on MRI

Answer 12

y

Question 13

often used as symptomatic treatment. It is an antagonist of GABA receptor ?

Answer 13

Baclofen

Question 14

how do you manage urinary incontinence?

Answer 14

oxybutanin or self catheterisaton

Question 15

a condition affecting the movement of the eyes which is characteristic of MS?

Answer 15

internuclear opthalmoplegia

Question 16

in INO, when patient looks to left what happens?

Answer 16

let eye is fine, right eye does not go past midline

Question 17

in INO, when patient looks to right what happens ?

Answer 17

right eye is fine, left eye does not go past midline

Question 18

what is the definitive investigation in MS?

Answer 18

MRI

Question 19

in visual evoked potentials, a delayed response indicates what?

Answer 19

there is evidence of some sort of optic nerve lesion

Question 20

what other conditions can mimic lesion on MRI?

Answer 20

sarcoidosis, SLE, bechets syndrome

Question 21

what is the severity of the disease like ?

Answer 21

Some patients may be able to live normally for many years, whilst other will becomes severely disabled.

Question 22

female to male?

Answer 22

f:m 3:1

Question 23

what pyramidal dysfunction ?

Answer 23

increased tone, spasticity and weakness

Question 24

weakness in arms and legs?

Answer 24

weakness in extensors in arms and flexors in legs

Question 25

you get loss of dorsal column. what does this cause?

Answer 25

proprioception and vibration (DEE PEE VEE)

Question 26

you get pain and paraesthesia

Answer 26

y

Question 27

what cerebellar defects can you get?

Answer 27

ataxia

Question 28

what criteria is used for diagnosis?

Answer 28

mcdonalds

Question 29

to satisfy dissemination in place, you need?

Answer 29

objective evidence of neurological deficits localised in two sepatrate parts of the CNS

Question 30

for dissemination in time, you need?

Answer 30

onset of neurological deficits separated by at least one month

Question 31

what are blood tests like in MS?

Answer 31

negative

Question 32

for spastcity, what can you give?

Answer 32

BT - baclofen or tizanidine. or botulinum toxin

Question 33

For sensory symptoms, can give?

Answer 33

sense maga

amytriptyline or gabapentin

Question 34

for urinary symptoms of frequency etc. tx?

Answer 34

Bladder drill, anticholinergics eg oxybutanin,desmopressin and catheterisation

Question 35

for fatigue?

Answer 35

Amantadine and modafinil (amanmod)

Hyperbaric oxygen

Question 36

First line therapy

Answer 36

Interferon Beta – avonex,rebif, betaseron,extavia

Glitiramer acetate

Techfedira

Question 37

Second line therapy

Answer 37

Monoclonal antibodies tysabri, lemtrada, zymbrata

Fingolimod

Question 38

Third line

Answer 38

mitoxantrone

Question 39

S1P modulator ?

Answer 39

fingolimod