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Block 8 Week 5 Colt > MS - Bloch > Flashcards

MS - Bloch Flashcards

1
Q

Where is there a greater geographic risk of MS?

A

the farther away from the equator; Reno and farthernorth

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2
Q

What two groups of people never get MS?

A

Inuits and Laplanders of Northern Scandinavia

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3
Q

Less sun exposure leads to a (higher/lower) risk of MS

A

higher

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4
Q

How many times more likely are women to get MS?

A

2-3x

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5
Q

when do women usually get their first MS attack/

A

after first pregnancy; espcially after nursing as the hormones affect the immune system

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6
Q

How long is a cancer Dx postponed in pts with MS?

A

10 years

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7
Q

What vitamin has a huge protective factor against MS?

A

vitamin D; >20 minutes of sun per day

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8
Q

what are the symptoms of MS?

A 
severe pain under eye (has moved to eye)
blurry vision
memory problems
FATIGUE
leg numbness
hip pain indicates spinal lesion
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9
Q

when is MS onset most common?

A

20s-30s

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10
Q

Describe the MOA of MS?

A

WBCs see myelin as foreign, cross the BBB and cause white matter lesions

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11
Q

Why is optic neuritis a common manifestation of MS?

A

high vascularization leads to larger WBC deposition

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12
Q

What percent of pts progress from optic neuritis to MS?

A

90%

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13
Q

T/F: DMARDS should be started at the time of the first MS attack

A

true

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14
Q

T/F: MS is more common with other autoimmune presentation

A

true

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15
Q

What are the side effects of betaseron (IFN)?

A

fatigue and flu like sx

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16
Q

By what percent does betaseron reduce the relapse rate of MS?

A

30%

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17
Q

What are the side effects of copaxone?

A

welts and liponecrosis

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18
Q

What is the MOA of copaxone?

A

co-polymer with unknown MOA; thought to maybe create a protective layer that makes it harder for WBCs to attack

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19
Q

What is the first oral DRMARD?

A

Fingolimide

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20
Q

What is the MOA of fingolimide?

A

sphingosoine receptor agonist

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21
Q

which cells have sphingosine receptors?

A

T cells

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22
Q

What happens with fingolimide attaches to T cells?

A

enter lymph nodes and never leave; no WBC circulation

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23
Q

What are the side effects of fingolimide?

A

heart
BP
eye

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24
Q

By what percent does fingolimide reduce relapse rates/

A

50%

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25
Q

What is the most effective drug in MS?

A

Tysabri

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26
Q

what is the MOA of tysabri?

A

prevents T cells from crossing the BBB

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27
Q

by what percent does tysabri reduce relapse rates?

A

70%

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28
Q

What are the issues that present after being on tysbri for 2 years or more?

A

increased risk of certain infections

increased reactivation of the John Cunningham virus (leads to PML progressive multifocoal leukoencephalopathy)

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29
Q

In which group of pts on tysabri will get PML from a JC virus reactivation/

A

HIV or chemo pts

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30
Q

T/F: you can develop allergies to tysabri and IFN treatment

A

true

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31
Q

T/F: life expectancy is now normal in pts with MS

A

true

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32
Q

MS is associated with which HLA protein?

A

HLA-DR2

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33
Q

what are some of the proinflammatory neurotoxic factors?

A 
TH1 and TH17 cytokines
TNF
IL-1
osteopontin
leukotrienes
MMP
plasminogen activators
nitric oxide
reactive oxygen species
glutamate
antibody + complement
cell-mediated cytotoxicity
neurotrophins via p75NTR?
34
Q

what are the anti-inflammatory and neuroprotective factors?

A 
TH2 cytokines
TGF-beta
soluble TNF receptor
soluble IL-1 receptor
IL-1 receptor antagonist
some prostaglandins
lipoxins
TIMP
antithrombin
***BDNF
NGF	
NT3              neurotrophic NT4/5                factors
GDNF
LIF ***
35
Q

In MS, (blank) type cytokines predominate

A

proinflammatory

36
Q

Active inflammation has what two destructive effects on neurons?

A

demyelination

axonal transectoin

37
Q

at what age do you normally get MS?

A

between 20 and 50; Dx in young kids and older adults; women:men 2-3:1

38
Q

What ethnicity gets MS more often?

A

N. european; more common in caucasians than hispanics or African americanns; RARE IN ASIANS

39
Q

MS is more common in which biome?

A

temperate climes

40
Q

what percent of people with MS have a blood relative with MS?

A

20%

41
Q

What are multiplex families?

A

there is a higher risk in families in which there are multiple family members with MS

42
Q

Is MS a clinical or lab Dx?

A

clinical

43
Q

What are the paraclinical tests that support an MS dx?

A

MRI
spinal fluid
evoked potentials

44
Q

What are the Dx criteria for MS?

A

dissemination in time and space: evidence that damage has occurred in two separate areas of the CNS at diff. pts in time

45
Q

What is the workup up order for Dx of MS?

A
  1. MRI with gadolinium
  2. Potential MS mimetics rule out (blood testing)
  3. LP (OBs and/or elevated IgG index or synth)
  4. Evoked potentials
46
Q

What is clinically isolated syndrome?

A

first neuro event suggestive of demyelination; at high risk for developing MS if multiple silent lesions on MRi

47
Q

What are the two most common types of CIS?

A

optic neuritis

transverse myelitis

48
Q

What are the Sx of optic neuritis?

A

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

49
Q

what are the Sx of transverse myelitis?

A

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

50
Q

On MRI, what is the strongest correlation with progression of disability?

A

T1 precontrast black holes; shows axonal loss

51
Q

what do you see on T1 gadolinium post contrast MRI?

A

white spots that show active BBB breakdown

52
Q

What do you see on FLAIR MRI?

A

MS lesions as white spots

53
Q

What do you see on T2 MRI?

A

the spinal fluid and the lesions both show up as white so its harder to tell what the fuck is going on

54
Q

Which DMARDS are approved for relapsing forms of MS?

A 
IFNb-1b
IFNb-1a IM and SC
Fingolimod
dimethyl fumarate
Tysabri **as monotherapy**
55
Q

Why are tysabri and mitonaxotrone second line therapy?

A

safety concerns even though they are better tolerated

56
Q

which DMARD is a humanized Mab?

A

tysabri

57
Q

what type of MS is copaxone approve for?

A

relapsing-remitting MS

58
Q

What are the negative prognostic indicators for MS?

A 
Frequent, multifocal attacks
Heavy MRI burden on initial scans
Pyramidal involvement
Ataxia
Cognitive difficulties
5 year accumulation of disability
Spinal progression (primary progressive MS)
59
Q

What is the immediate Tx for a relapse?

A

corticosteroids if it sig. interferes with ADLs

Rehab if necessary

60
Q

how do you define a relapse?

A

new neuro symptom lasting 24 hours or worsening of old symptom

61
Q

What is the most common MS symptom?

A

fatigue

62
Q

What are the “visible” symptoms of MS?

A 
Spasticity
Gait, balance, and coordination problems
Speech/swallowing problems
Tremor
Weakness
63
Q

What drug is approved to increase walking speed in MS?

A

Dalfampridine; oral K channel blocker that speeds nerve conduction

64
Q

T/F: sensitivity to heat or cold can happen in MS

A

true; but heat is more common

65
Q

How does an infection worsen MS symptoms

A

through raising the body temp

66
Q

What’s an easy way to tell if someone is having a true relapse or a pseudoexacerbation?

A

urine screen for a UTI

67
Q

What druugs can you give to treat the “small bladder” in MS?

A

oxybutynin
Tolteridine
trospium chloride

68
Q

what drugs can you give to treat the “large bladder” in MS?

A

stimulating meds

intermittent self-catheterization

69
Q

What drugs can you give to treat the dysynergic bladder?

A

Alpha adrenergic agonists like dibenzyline, terazosin ,Cardura, and put in a catheter

70
Q

What can you give to treat nocturia?

A

DDAVP- desmopressin

71
Q

What drugs can you give to manage MS pain?

A 
gabapentin
lamotrigine
carbamazepine
amitriptyline
pregabalin
72
Q

what kind of pain is MS pain?

A

burning, irritating, neuropathic pain

73
Q

What psych disorder is often confused with MS symptoms?

A

depresssion; it is UNDER Dx’d and treated

74
Q

What is the Tx for MS and depression?

A

Psychotherapy, meds, and exercise

75
Q

what percent of people with MS will experience an MDD?

A

greater than 50%

76
Q

suicide is how many more times common in MS pts?

A

7.5x

77
Q

T/F: cognitive impairment is common in MS

A

false!!; only occurs in late or severe stages

78
Q

Because MS is a white matter disease it does not effect what three architectural properties of the brain?

A
  1. brain volume
  2. gray matter
  3. cerebral cortex
79
Q

What are the causes for memory problems in MS?

A

stress
anxiety
depression

80
Q

Cogntive function correlates with…

A

lesion load and brain atrophy

81
Q

T/F: cognitive dysfunction can occur as a first symptom in MS

A

true; although it normally happens later on; most common PROGRESSIVE MS

82
Q

T/F: depression can worsen cognition

A

true

Block 8 Week 5 Colt (12 decks)

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