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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?

24
Q

What does the CSF contain in MS patients?

A
  • Oligoclonal bands

- IgG

25
What are the 4 types of MS? Which is MC?
- Relapsing-remitting (MC!) - Primary progressive - Secondary progressive - Progressive-relapsing
26
Describe relapsing-remitting MS.
Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission
27
What is the Schumacher diagnostic criteria?
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
What is the McDonald MS criteria?
Look at PDF on Bblearn
29
What does dissemination in space (DIS) mean?
Neurological deficits localized to 2 separate parts of the CNS
30
What does dissemination in time (DIT) mean?
Onset of neurological deficits separated by at least 1 month
31
What medications can be used for tx of MS?
- Corticosteroids for acute exacerbation - Disease modifying agents: decreases relapses - Immunosuppressives - Tx targeting focal neurological deficits
32
What meds can help w/ fatigue in MS?
- Amantadine - Adderall - Modafinil
33
How do you tx cognitive changes in MS?
- Teach to make lists - Use calendar - Use tape recorder - Start diary - Limit noise during convos - Repeat info & write down important points - Crossword puzzles
34
How do you tx depression in MS?
- SSRIs - Tricyclic antidepressants - Counseling - Psychologist - Encourage expression of feelings
35
What is MG? What is it caused by?
- Rare autoimmune disorder | - Caused by antibody-mediated blockade --> weakness
36
What is the chief target of autoimmune attack in most cases of MG?
skeletal muscle nicotinic acetylcholine receptor
37
What populations do you most commonly see MG in?
Women - 3rd decade | Men - 6th/7th decade
38
What are the 2 main sx of MG, seen at initial presentation?
- Ptosis | - Diplopia
39
What is the hallmark of MG?
Muscles get weaker w/ repeated use
40
What are other signs & sx of MG?
- ocular sx w/ or w/out weakness - development of generalized weakness, often 3 yrs after onset - bulbar muscle weakness - limb weakness
41
What factors may trigger or worsen sx of MG?
- Warm weather - Surgery - Immunization - Emotional stress - Menstruation - Illness/infection - Pregnancy/ postpartum
42
What are PE findings?
- 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
What is the most reliable test for dx MG?
Anti-acetylcholine receptor antibody test
44
How can you identify a thymoma in MG?
- CXR | - CT: r/o thymoma or enlargement
45
What is the ice pack test?
Used in MG | - May improve ptosis & diplopia (via neuromuscular transmission)
46
How do you manage MG?
- 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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