MS - Hon

Question 1

Define MS

Answer 1

A disorder of the brain and spinal cord characterized by a tendency for periods of increasing and decreasing symptoms and signs (exacerbations and remission) which results from loss of nerve tract insulation (myelin) at multiple sites in the CNS

Question 2

What are the common presentation with MS

Answer 2

• paresthesias
• Gait disturbances
• weakness
• visual loss
• urinary difficulty
• dysarthria
• hemiparesis

Question 3

About half the patients are usually in what phase of the disease?

Answer 3

Relapsing remitting

Question 4

What imaging study is usually used to diagnose MS and what is often found on those images?

Answer 4

MRI of the head, C and T spine. Typically see ovoid lesions of high signal on T2W1 in the periventricular white matter and in the spinal cord. Acute lesion may enhance.

Question 5

In CSF, what are you likely to find for a pt with MS?

Answer 5

oligoclonal bands and/or increased IgG index/synthesis rate are typical findings in M.S. patients.

Question 6

what is the quick and easy with to diagnose MS for a patient who shows signs of MS?

Answer 6

multiple lesions over space and time.

Question 7

What disease-modifying medications are used for MS?

Answer 7

these drugs decrease frequency and severity of exacerbation and slows the progression of the disease. They include; interferon beta 1A (avonex); interferon beta 1B (Betaseron); natalizumab, finglomimod, teriflunomide, dimehtyl fumate, aletuzmuab,

Question 8

What medications are used to treat an acute exacerbation in MS, but is not considered a disease modifying drug?

Answer 8

Steroids. high dose of corticosteroids (solumederol) followed by predinosone.

Question 9

Pt presents with - paresthesias
-Gait disturbances 
-weakness
-visual loss 
-urinary difficulty
-dysarthria
-hemiparesis. 
Pt denies any previous history of these symptoms.  What is the most likely diagnosis?

Answer 9

If this the first time pt is presenting with these symptoms, it is almost impossible to differentiate these symptoms which sounds like MS from other post-infectious or post immunization enchphalomyelopathy (ADEM). If pt gets better and does not get these symptoms in the future. its likely ADEM and NOT MS.

Question 10

what disease are considered in the DDX of pts who presents with symptoms that sounds like MS?

Answer 10

• autoimmune disease, e.g SLE
• Devics disease (neuromyelitis optica)
• B12 deficiency
• lymphoma or leukemia with CNS involvement
• spinocerebellar ataxia
• vascular malformation
• infection
• granulomatous disease (sarcoidosis)
• metachromatic leukodystrophy, adrenomyeloleukodystrophy

Question 11

What are some drugs that can be treat the following symptoms in pts with MS
A. Spasticity
B. Intention tremor
C. Urinary urgency 
D. Urinary retention
E. Painful dysesthesias
F. Fatigue

Answer 11

A. bacflofen, tizanadine, diazepam, carbemazepine, BoTox, dantrolene
B. propranolol, primidone, clonazepam
C. Oxybutinin, detrol
D. bethanechol
E. carbaemezepine, oxcarbamzepine, gapapentin, phenytoin, baclofen
F. amantadine, modafinil, armodafinil, fluoxetine, buproprion etc