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Neurology > MS > Flashcards

MS Flashcards

1
Q

what is multiple sclerosis

A

autoimmune inflammatory demyelinating disorder of the central nervous system

  • chronic
  • degenerative
  • immune mediated
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2
Q

what are plaques

A

inflammatory areas

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3
Q

what does dissemination in time and space mean

A

plaques are found at different times in different places

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4
Q

does this disorder affect the PNS

A

no, it only affects the CNS

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5
Q

males/females are more affected by MS

A

females

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6
Q

what is the epidemiology and RF of MS

A 
F>M
30-40s 
those who live further away from the equator 
genetics
EBV
HHV 6
vit D deficiency
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7
Q

what are the 4 clinical courses of MS

A

relapsing remitting
secondary progressing
progressive relapsing
primary progressive

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8
Q

define relapse/exacerbation

A

new symptoms / significant worsening of existing symptoms lasting more than 24 hours with preceding 30 days of clinical stability

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9
Q

list the clinical features of MS (6)

A 
Pyramidal dysfunction 
Visual symptoms
Sensory deficits 
Lower urinary tract dysfunction 
Cerebellar and brainstem dysfunction 
cognitive impairment and fatigue
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10
Q

describe pyramidal dysfunction in MS

A

hypertonia and spasticity
hyper reflexia
weakness of upper limb extensors and lower limb flexors

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11
Q

describe visual disturbances in MS

A

optic neuritis

internuclear ophthalmoplegia

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12
Q

what is optic neuritis

A

painful visual loss because of inflammation of the optic nerve
RAPD seen

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13
Q

describe sensory deficits in MS

A 
pain 
paraesthesia 
"water trickling" sensation 
numbness 
DCML loss 
trigeminal neuralgia
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14
Q

describe lower urinary tract dysfunction in MS

A 
frequency 
urgency 
urinary incontinence
urinary retention 
nocturia
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15
Q

describe cerebellar and brainstem dysfunction in MS

A

DANISH symptoms

diplopia + facial weakness from CN palsies

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16
Q

describe internuclear ophthalmoplegia

A

impaired:
ipsilateral adduction
contralateral abduction nystagmus

17
Q

how is a diagnosis of MS made

A

at least 2 episodes suggestive of demyelination
dissemination in time and space
alternative diagnoses excluded

18
Q

what investigations are carried out to diagnose MS

A 
history and clinical examination 
MRI
CSF 
neurophysiology 
blood tests
19
Q

what is MRI looking for

A

T2 weighted MRI to look for dissemination in time and space

20
Q

what do you look for in CSF

A

oligoclonal bands

21
Q

what blood tests are done

A 
FBC
CRP
LFT
U+E
PV
bone profile 
Ab screen 
borellio
HIV
syphilis 
serology
B12
folate
Vit D
22
Q

what are differential diagnoses of MS

A 
vasculitis 
granulomatous disorders 
vascular disease 
structural lesion
infection 
metabolic disorder
23
Q

3 approaches to management of MS

A

acute exacerbation
symptomatic treatment
disease modifying therapy

24
Q

steps in management of acute exacerbation

A

mild - symptomatic treatment
moderate - PO steroids
severe - IV steroids

25
Q

give examples of symptomatic treatment for pyramidal weakness

A

PT + OT
anti-spasmodics
botox, intra thecal baclofen

26
Q

give examples of symptomatic treatment for sensory symptoms

A 
anticonvulsants 
antidepressants 
TENS machine 
acupuncture 
lignocaine infusion
27
Q

give examples of symptomatic treatment for LUT dysfunction

A

reduce caffeine
anti cholinergics - oxybutynin
desmopressin
catheterisation

28
Q

give examples of symptomatic treatment for fatigue

A

amantadine
modafinil if sleepy
hyperbaric oxygen

29
Q

how many lines of therapy are there in disease modifying therapy

A

1st, 2nd and 3rd

30
Q

list first line disease modifying therapy

A

Tecfidera PO

Interferon B and Glitiramer acetate - SC + IM

31
Q

which drug is 1st line after RR MS

A

tecfidera

32
Q

list 2nd line disease modifying therapy

A

Fingolimod and Cadrabine - PO

Tysabri

33
Q

what kind of drug is tysabri

A

monoclonal antibody

34
Q

what disease can tysabri cause

A

progressive multifocal leukoencephalopathy PML

35
Q

list 3rd line disease modifying therapy

A

Mitroxantrone and Lemtrada

HSCT - horizontal stem cell transplant

Neurology (25 decks)

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