MS

Question 1

What are the three characteristics of a LMN? (Tone, reflexes, fasciculation)

Answer 1

Decreased tone and decreased reflexes

Fascciculations are present

Question 2

Most common demyelinating disease:

Answer 2

MS

Question 3

Hallmark of MS is:

Answer 3

Axonal injury

Question 4

Locations of lesions in MS (5):

Answer 4

1. Optic nerves
2. Spinal cord
3. Brainstem
4. Cerebellum
5. Juxtacortical and periventricular white matter

Question 5

Three hallmarks of MS:

Answer 5

• Axon/neuron loss
• Demyelination
• Astrocytic glosis

Question 6

Highest risk for MS and age data:

Answer 6

White females - onset is 5 years before men (average age is 20-50 *37 is dx age)

Question 7

Low levels of white vitamin contribute to MS:

Answer 7

Vitamin D

Question 8

Diagnosis criteria for MS:

Answer 8

Present as a young adult with two or more clinically distinct episodes of CNS dysfunction with at least partial resolution

Question 9

Common signs and symptoms (3):

Answer 9

• Sensory limb changes
• Vision loss
• Motor/gait disturbances

Question 10

What is Lhermitter’s sign in MS?

Answer 10

Transient sensory symptoms of electric shocks radiating down the spine and into the limbs when you flex the neck

Question 11

What is an early sign of MS in young people?

Answer 11

Trigeminal neuralgia

Question 12

Two visual disturbances in MS:

Answer 12

• Optic neuritis (most common)

- Internuclear ophthalmoplegia

Question 13

What is optic neuritis? When do they recover?

Answer 13

Unilateral subacute eye pain that is increased with eye movement - followed by some vision loss (dampening of colors) - 90% return to normal in 2-6 months

Question 14

Someone currently experiencing optic neuritis will have a:

Answer 14

Marcus Gunn pupil - lesion isolated retrobulbar

Question 15

What would you see on a fundoscope exam of a person with optic neuritis?

Answer 15

Pale disc; temporal pale ness

Question 16

What is most suggestive of MS when looking at someone’s eyes?

Answer 16

Bilateral INO

Question 17

What is internuclear ophthalmoplegia? What happens with convergence?

Answer 17

Abnormal horizontal eye movements (cannot adduct the eye) - Result: nystagmus **CONVERGENCE IS PRESERVED

Question 18

Where is the lesion in someone with INO in MS?

Answer 18

Medial longitudinal fasiculus on the side that CANNOT adduct anymore

Question 19

There is quite a bit of spasticity in MS: Which extremity experiences it more?

Answer 19

Lower extremity

Question 20

Extensor (babinski) test is ___ in someone with MS

Answer 20

Positive

Question 21

DTRs and clonus in someone with MS?

Answer 21

DTRs are exaggerated and there is often clonus

Question 22

What is disuse amyotrophy:

Answer 22

Affecting the small muscles of the hand

Question 23

What is Uhtoff’s sign?

Answer 23

When neurological symptoms are worsened in MS when the body is overheated, exercise, fever or hot tub

Question 24

MS is not ____

Answer 24

Progressive - instead it is normal to have relapses and remissions

Question 25

What is the Clinical Isolated syndrome?

Answer 25

The first attack of the disease that shows symptoms (ex. optic neuritis) but does not fulfill the criteria

Question 26

If you have CIS and MRI lesions your change of developing MS later is

Answer 26

60%

Question 27

Most people seek medical attention after they have had a CIS and __

Answer 27

Are experiencing their much worse second episode - GET MRI

Question 28

What is Relapsing-Remitting MS?

Answer 28

Defined relapses with recovery. No disease periods of progression in between. (City sky line)

Question 29

What is Secondary progressive MS?

Answer 29

Initially like relapsing-remitting but then the patient beings to progress between each episode

Question 30

The transition to RRMS to SPMS occurs when after disease onset?

Answer 30

10-20 years after onset

Question 31

What category of MS causes the most neurological disability?

Answer 31

SPMS

Question 32

What is Primary progressive MS?

Answer 32

Patient continues to get worse without periods of remission - NO ACUTE ATTACKs

Question 33

Most common form of MS?

Answer 33

Relapsing-Remitting MS

Question 34

What is the test of choice to Dx MS?

Answer 34

MRI - Will see plaques in the periventricular or corpus callous

Question 35

What occurs at a rate of 0.5-1.5% each year in someone with MS?

Answer 35

Brain atrophy - Do not see this initially

Question 36

What is another test you do to look for MS (quality assessment)? What are you looking for?

Answer 36

CSF - Looking for oligoclonal bands

Question 37

What is Evoked potentials and what area is used the most?

Answer 37

Brain waves are recorded by stimulating a peripheral nerve - visual is used the most often

Question 38

To diagnose MS you need what according to the McDonald criteria?

Answer 38

1. Disseminated in space: one more more lesions in at least two of four MS areas of the CNS OR developing further clinical attacks in another area of the CNS
2. Disseminated in time: PResnece of an asymptomatic lesion or a new lesion follow-up on MRI
   * You need to have two distinct episodes of MS

Question 39

Treatment of MS: acute and chronic

Answer 39

Acute: plasmapheresis and steroids
Chronic: immunotherapy - interferons and ab

Question 40

When should you medicate someone with MS and spasticity?

Answer 40

If it is moderate - bento, gabapentin

Question 41

Treatment of severe spasticity?

Answer 41

Cut the muscle or chemicals

Question 42

If the patient is having bladder problems you should (2):

Answer 42

Rule out an infection and ultrasound

Question 43

If someone with MS has urinary incontinence, you can prescribe them:

Answer 43

Antispasmotics

Question 44

If someone is urinary retaining, you should suggest:

Answer 44

Self-catherization