MS-bloch

Question 1

What is MS?

Answer 1

an immune-mediated disease of the CNS

Question 2

Immune cells are made throughout the body except in the (blank and blank)

Answer 2

brain and spinal cord

Question 3

In MS you have imbalance between what 2 things?

Answer 3

proinflammatory and anti-inflammatory cytokines

Question 4

What is this:

an immune mediated disease of the CNS, it is a disease of myelin and axons

Answer 4

multiple sclerosis

Question 5

MS is a disease of axons and (blank)

Answer 5

myelin

Question 6

It has been shown that active inflammation results in both (blank) and (blank)

Answer 6

demyelination and axonal transection

Question 7

Who typically gets MS?

Answer 7

Women (3:1 men) typically in their 20-50s, typically caucasians (rare among asians)
common in temperate areas of the owrld

Question 8

Where do you have the least amount of MS?

What are some variables that might be related to MS?

Answer 8

on the equator, the further north or south of this the more likely you will have MS

-environmental factors, genetic factors, lower vit D exposure, combo

Question 9

(blank) percent of people with MS have a blood relative with MS which means that it is a (blank and blank) disease

Answer 9

20%

genetic and environmental

Question 10

T or F

The risk of MS is higher in any family in which there are several family members with the disease (multiplex families)

Answer 10

T

Question 11

The risk of getting MS is:
for the gen pop?
first degree relative?
identical twin?

Answer 11

0.1%
3%
25%

Question 12

MS is a (blank) diagnosis

Answer 12

clinical (signs and symptoms and medical history)

Question 13

What tests are helpful in diagnosing MS and what is the diagnostic criteria?

Answer 13

Paraclinical tests provide support
-Magnetic resonance imaging
-Spinal fluid
-Evoked potentials
Diagnostic criteria:
-Dissemination in time and space: evidence that damage has occurred in at least two separate areas of the CNS at different points in time
-There must be no other explanation

Question 14

What are potential symptoms of MS?

Answer 14

Numbness
Diplopia
Visual Loss
Bladder Dysfunction
Gait Impairment
Fatigue
Vertigo
Bowel Dysfunction
Cognitive Dysfunction
Pain
Depression
Sexual Dysfunction
Paresis

Question 15

What factors should increase your suspicion for MS?

Answer 15

• female
• age 25-40
• clinically isolated syndrome (CIS)
  i. e optic neuritis, transverse myelitis

Question 16

What is the MS work-up?

Answer 16

1) MRI with gadolinium
2) Potential MS mimetics ruled out (blood testing, etc)
3) Lumbar Puncture (OBs and/or elevated IgG index or synthesis)
4) Evoked Potentials

Question 17

(blank) is the first neurologic event suggestive of demyelination. Individuals with (blank) are at high risk for developing clinically definitie MS if the neurologic event is accompanied by multiple, clinically silent (asymptomatic) lesions on MRI typical of MS.

Answer 17

Clinically Isolated Syndrome (CIS)

CIS

Question 18

What are the 2 common clinically isolated syndromes (CIS)?

Answer 18

optic neuritis

transverse myelitis

Question 19

What is this:
Sudden, but transient loss of visual acuity
Unilateral or bilateral
Retro-orbital pain exacerbated by eye movement
Normal optic disc
Reduced color perception
Decreased vision following activities that elevate body temperature

Answer 19

optic neuritis

Question 20

What is this:
Ascending numbness from the feet, up the torso, potentially from hands to arms
Ataxia, balance problems 
Electric shock sensations while flexing neck
Partial or complete paralysis
Bladder dysfunction 
Bowel dysfunction
Sexual dysfunction

Answer 20

transverse myelitis

Question 21

What is the most common type of MS?

Answer 21

Relapsing-remitting (RR) MS

Question 22

(blanK) begins as RR disease. The vast majority of people with RR disease eventually develop SP MS, in which the disease becomes more steadily progressive, with or without relapses. At any given time about 30% of the general MS population is SP.

Answer 22

Secondary-progressive (SP) MS

Question 23

(blank) MS affects about 10% of patients. In PPMS, the disease is progressive from onset, without any relapses or remissions.

Answer 23

Primary-progressive (PP)

Question 24

(blank) MS is the least common form, affecting about 5% of patients. In PRMS, the disease is progressive from onset, with occasional relapses along the way.

Answer 24

Progressive-relapsing (PR)

Question 25

What are the negative prognostic indicators for MS?

Answer 25

Frequent, multifocal attacks
Heavy MRI burden on initial scans
Pyramidal involvement
Ataxia
Cognitive difficulties
5 year accumulation of disability
Spinal progression (primary progressive MS)

Question 26

What is this:
new symptom or sudden worsening of old symptom lasting at least 24 hours, and usually accompanied by an objective change in neurologic findings
How do you treat this?

Answer 26

relapse
corticosteroids (high dose oral steroids or high dose IV methylprednisolone)
OR
Rehab

Question 27

What drug can improve walking speed in MS?

Answer 27

Dalfampridine

Question 28

(blank) sensitivity is common in MS

Answer 28

heat

sensitivity to cold can also occur

Question 29

Even a slight elevation in core body temperature can cause temporary worsening of symptoms this is called a (blank).
Cooling strategies are beneficial during:
Hot, humid weather
Exercise
Cooking

Answer 29

pseudoexacerbation

Question 30

Infections of any kind can increase body temperature and thereby cause a sudden worsening of symptoms. Checking for a (blank) is one important strategy for determining if a person is having a true relapse or a pseudo relapse.

Answer 30

urinary tract infection

Question 31

How can you treat bladder dysfunction in MS (CANT STORE urine)?

Answer 31

Oxybutynin in various forms
Tolteridine
Trospium chloride

Question 32

How can you treat bladder dysfunction in MS (CANT EMPTY urine)?

Answer 32

Stimulating medication

Intermittent self-catheterization

Question 33

How do you treat dysnergic bladder?

Sometimes the bladder contracts while the sphincter (the exit from the bladder) contracts as well. This is called a dysynergia.

Answer 33

Alpha adrenergic agonists
-dibenzyline, 
-terazosin (Hytrin), 
-Cardura
Intermittent self-catheterization

Question 34

How do you treat nocturia?

Answer 34

DDAVP-desmopressin

Question 35

How do manage bowel dysfunction in MS?

Answer 35

Regular bowel regimen
High fiber diet; sufficient liquids
Bulk formers
Stool softeners
Mini enemas
Suppositories
Enemas

Question 36

How do you manage dysethesia or parasthesias?

Answer 36

Pharmacological:  
-gabapentin
-lamotrigine 
-carbamazepine
-amitriptyline
-pregabalin 
Mechanical:  gloves, counter-irritant
Other:  accupuncture, biofeedback

Question 37

Whats the pain like in MS?

Answer 37

a burning, irritating “neuropathic” pain

Question 38

People with MS often are depressed, how do you treat this?

Answer 38

psychotherapy and medication and exercise

Question 39

Suicide is (blank)x more common in MS than in general population

Answer 39

7.5X

Question 40

Is cognitive impairment common in MS?

Answer 40

no, it only occurs in late stage MS or severe MS

Question 41

MS is a white matter disease and does not affect what three things?

Answer 41

• brain volume
• gray matter
• cerebral cortex

Question 42

If an MS patient can pass a brief mental status exam, everything is OK.
Memory problems reported by MS patients are usually caused by what?

Answer 42

stress, anxiety, and/or depression.

Question 43

(blank) correlates with lesion load and brain atrophy.

Answer 43

Cognitive function