MS

Question 1

what is Multiple Sclerosis

Answer 1

Chronic Inflammatory demyelinating disease of the CNS

Question 2

Prevalence of MS and average age of onset

Answer 2

commonest cause of neurological deficiency in adults
average onset 20-40 Y O
0.1% of population in UK

Question 3

Rf of MS

Answer 3

vit D defic
further from equator
fam history
childhood ebv exposure

Question 4

DDx of MS

Answer 4

sarcoidosis

sle

Question 5

diff types of MS

Answer 5

relapsing remitting
secondary progressive
primary progressive
progressive relapsing

Question 6

which type of ms in msot common

Answer 6

relapsing remitting (80%)

Question 7

what is secondary progressive MS

Answer 7

initally relpase n remiting then decline without remission

Question 8

what is primary prgroessive MS

Answer 8

steady decline - prgoressive from the start

Question 9

what is progressive relapsing

Answer 9

steady decline from start w superimposed attacks

Question 10

what kind of hypersensitivty reactin in MS

Answer 10

type IV (4x types and type 4)

Question 11

what is charcots triad (neurological vs cholangitis)

Answer 11

MS = nystagmus, dysarthria, intention tremor

fever jaundice RUQ pain

Question 12

what are clinical features of MS

Answer 12

DEMYELINATION
Diplopia
Eyemovement painful (optic neuritis)
Motor weakness
nYstagmus
Elevated temp worsens (Uhthoffs)
Lhermittes sign 
Intention tremor
Neuropathic pain
Ataxia
Talking slurred (dysarthria)
Impotence (erectile dystfunction)
Overactive bladder
Numbness (pins n needles)

Question 13

in terms of plaque deposition - CFs on plaques in motor pathway

Answer 13

muscle weakness
tremor
ataxia
paralysis

Question 14

in terms of plaque deposition - CFs on plaques in brainstem

Answer 14

dysarthria - concious movements (eating talking)

unconcious (swallowing)

Question 15

in terms of plaque deposition - CFs on plaques in sensory from skin

Answer 15

paresthesias

Lhermittes sign - electric shock runs down back and radiates to limbs on bending neck forwards

Question 16

in terms of plaque deposition - CFs on plaques in optic nerve

Answer 16

optic neuritism - loss of vision
central vision loss
diplopia
painful eye movements

Question 17

in terms of plaque deposition - CFs on plaques in autonomic nervouse system

Answer 17

erectile dysfunction

bowel and bladder symptoms (overactive bladder)

Question 18

pathophysiology of MS

Answer 18

type IV t cell mediated hypersensitivyt reaction (delayed hypersensitivyt)
autoantibodies vs myelin (OLIGODENDROCYTES CELL BASED SPECIFIC)
cytokines - inflam - discrete plaques of myelination = obstruct conduction
myelin sheath can regen - not as good = heat dependent (UHTHOFFS PHENOMENON)
repeated = axonal loss
= INCOMPLETE RECOVERY BETWEEN ATTACKS

Question 19

what is Uthoffs phenomm

Answer 19

in MS
symptoms worse when hot
i.e post hot bath
due to heat slowing down conduction

Question 20

Dx of MS criteera

Answer 20

McDonalds
2+ attacks with demyleination plauques
DISEMINATED IN SPACE AND TIME (dr who tardis)
exclude all other causes

Question 21

Dx of MS

Answer 21

MRI- tries to identify demyelinating plaque or exclude other causes
CSF analysis - shows inflammatory markers in CSF
No inflammation in bloods. oligoclonal IgG bands (high conc)
electrophysiology - delayed nerve conduction evoked potentials

Question 22

Management of MS

Answer 22

NO CURE
relapse and remitting - acute attacks = IV methylprednisolone steroids = disease mod
chronic - alemtuzumab (CD52 monoclonal antibody)
or Natalizumab
SYMPTOMATIC
antispastic - baclofen
antidepress - SSRI sertaline
tremor - BBs - propanolol (CI in asthma)
nerve pain - gabapentin