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Foundations II (Cholley) > MS & MG > Flashcards

MS & MG Flashcards

1
Q

What are characteristics of MS?

A
  • Autoimmune
  • Inflammation associated w/ multiple foci of demyelination
  • Progressive neurological dysfxn
  • Relapsing/remitting pattern
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2
Q

What is the pathophys of MS?

A

Inflammation, demyelination, & axonal degeneration

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3
Q

What is white matter?

A

Myelinated & unmyelinated axons

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4
Q

What is grey matter?

A

Neuronal cell bodies

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5
Q

What population is most commonly affected by MS?

A

Young women

  • ages 20-40
  • Leading cause of acquired disability
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6
Q

What causes MS?

A

Combo of:

  • Genes
  • Immune regulation
  • Environment
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7
Q

What vitamin deficiency is associated w/ MS?

A

Vit D!

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8
Q

Who is at increased risk for MS?

A

Those who have siblings w/ MS!

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9
Q

How does MS present?

A
  • CNS sx
  • Attack longer than 24hrs
  • Progression may occur in absence of exacerbations
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10
Q

What are classic MS sx?

A
  • Paresthesias
  • Spinal cord sx (motor & autonomic)
  • Cerebellar sx
  • Optic neuritis
  • Trigeminal neuralgia
  • Facial myokymia
  • Eye sx: Diplopia, lateral gaze
  • Heat intolerance
  • Pain
  • Depression
  • Cognitive difficulties
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11
Q

What is the 1st demyelinating event in MS? What is it characterized by?

A

Optic neuritis

  • Loss of vision in affected eye & pain on movement of eye
  • Phosphenes
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12
Q

How does acute transverse myelitis present in MS?

A

Acute PARTIAL loss of:

  • Motor
  • Sensory
  • Autonomic
  • Reflex
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13
Q

What is one of the MC sx of MS?

A

Fatigue (physical & mental)

- Major reason for unemployment

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14
Q

Describe spasticity in MS. Where does it occur?

A

Increased muscle tone & resistance to movement

- Occurs in muscles that fxn to maintain upright posture

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15
Q

Describe cognitive dysfxn in MS.

A
  • May occur early in course

- Affects family social relationships & employment

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16
Q

What are the 2 types of pain seen in MS?

A
  • Primary

- Secondary

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17
Q

What urinary sx are seen in MS?

A
  • Failure to store, empty

- Urgency, frequency, incontinence

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18
Q

What is the most frequent bowel complaint in MS?

A

Constipation

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19
Q

What should your neuro exam consist of when evaluating MS?

A
  • MMSE
  • CN
  • Reflexes
  • Motor
  • Sensory
  • Gait
20
Q

How does MS spasticity present?

A
  • Bent wrist
  • Closed fist
  • Flexed elbow
21
Q

What is the diagnostic workup for MS?

A
  • H&P
  • MRI brain/spine (enhanced)
  • Labs (to r/o mimics)
  • CSF (when MRI inconclusive)
  • Evoked potentials
22
Q

What labs can be ordered for MS?

A
  • CBC, CMP, UA
  • Lyme serology
  • ANA, RPR, ESR
  • B12
  • TSH
  • HIV
23
Q

What is the imaging procedure of choice for confirming MS & monitoring disease progression?

A

MRI

24
Q

What does the CSF contain in MS patients?

A
  • Oligoclonal bands

- IgG

25
Q

What are the 4 types of MS? Which is MC?

A
  • Relapsing-remitting (MC!)
  • Primary progressive
  • Secondary progressive
  • Progressive-relapsing
26
Q

Describe relapsing-remitting MS.

A

Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission

27
Q

What is the Schumacher diagnostic criteria?

A

6 criteria essential for dx of MS.

  1. 10-50 yo
  2. abnormalities on exam
  3. 2 or more separate lesions
  4. white matter involvement
  5. consistent over time
  6. no better explanation
28
Q

What is the McDonald MS criteria?

A

Look at PDF on Bblearn

29
Q

What does dissemination in space (DIS) mean?

A

Neurological deficits localized to 2 separate parts of the CNS

30
Q

What does dissemination in time (DIT) mean?

A

Onset of neurological deficits separated by at least 1 month

31
Q

What medications can be used for tx of MS?

A
  • Corticosteroids for acute exacerbation
  • Disease modifying agents: decreases relapses
  • Immunosuppressives
  • Tx targeting focal neurological deficits
32
Q

What meds can help w/ fatigue in MS?

A
  • Amantadine
  • Adderall
  • Modafinil
33
Q

How do you tx cognitive changes in MS?

A
  • Teach to make lists
  • Use calendar
  • Use tape recorder
  • Start diary
  • Limit noise during convos
  • Repeat info & write down important points
  • Crossword puzzles
34
Q

How do you tx depression in MS?

A
  • SSRIs
  • Tricyclic antidepressants
  • Counseling
  • Psychologist
  • Encourage expression of feelings
35
Q

What is MG? What is it caused by?

A
  • Rare autoimmune disorder

- Caused by antibody-mediated blockade –> weakness

36
Q

What is the chief target of autoimmune attack in most cases of MG?

A

skeletal muscle nicotinic acetylcholine receptor

37
Q

What populations do you most commonly see MG in?

A

Women - 3rd decade

Men - 6th/7th decade

38
Q

What are the 2 main sx of MG, seen at initial presentation?

A
  • Ptosis

- Diplopia

39
Q

What is the hallmark of MG?

A

Muscles get weaker w/ repeated use

40
Q

What are other signs & sx of MG?

A
  • ocular sx w/ or w/out weakness
  • development of generalized weakness, often 3 yrs after onset
  • bulbar muscle weakness
  • limb weakness
41
Q

What factors may trigger or worsen sx of MG?

A
  • Warm weather
  • Surgery
  • Immunization
  • Emotional stress
  • Menstruation
  • Illness/infection
  • Pregnancy/ postpartum
42
Q

What are PE findings?

A
  • weakness of facial muscles: sagging & expressionless face, horizontal smile.
  • Corners of mouth droop downward, pt looks sad
  • “Myasthenic snarl”
  • Pt unable to whistle, suck straw, or blow up balloon
43
Q

What is the most reliable test for dx MG?

A

Anti-acetylcholine receptor antibody test

44
Q

How can you identify a thymoma in MG?

A
  • CXR

- CT: r/o thymoma or enlargement

45
Q

What is the ice pack test?

A

Used in MG

- May improve ptosis & diplopia (via neuromuscular transmission)

46
Q

How do you manage MG?

A
  • Symptomatic therapy
  • AchE inhibitors
  • Pyridostigmine: maintenance
  • Neostigmine: only when pyrido is unavailable
  • Immunomodulating agents
  • Plasmapheresis
  • Immunosuppression (prednisone)
  • Thymectomy

Foundations II (Cholley) (25 decks)

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