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Nayla Foundations Exam 4 > MS/MG > Flashcards

MS/MG Flashcards

1
Q

What is Multiple Sclerosis

A

Autoimmune CNS disorder causing multiple foci of demyelination

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2
Q

What are the major mechanisms of MS

A

Inflammation
Demyelination
Axon damage

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3
Q

What regions of the brain are involved in MS

A

In White matter, myelinated and unmyelinated axons carry messages to grey matter
Grey matter has the neuron cell bodies and dendrites

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4
Q

Who is MS more prevalent is

A

white women 20-40

Disease of latitudes (NO eskimos)

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5
Q

What is the presumed etiology behind MS

A

genetically predisposed + Immunodeficient + Environmental factor = first exacerbation

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6
Q

What nutritional deficiency is linked to MS

A

Vitamin D

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7
Q

Who is genetically predisposed to MS

A 
if your sibling has MS, esp. identical twins 
HLA alleles (AI d/o): HLA DR2, HLA DR4
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8
Q

MS attacks must be

A

separated in time and space
last >24 hours
+/- progression (even w/o exacerbation)

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9
Q

Classic MS symptoms include

A 
*Optic Neuritis 
Paresthesias, diplopia, fatigue, pain, depression
Cerebellar Sx (ataxia, disequilibrium) 
Spinal cord motor Sx (muscle fatigue) 
autonomic dysfunction (bladder/bowel/sex) 
Cognitive difficulties (grey matter) 
Heat intolerance 
Sx of partial acute transverse myelitis
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10
Q

What is optic neuritis

A

Loss of vision and pain with movement in affected eye, due to inflamed optic nerve
*Phosphenes (seeing stars)

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11
Q

What is acute transverse myelitis

A

acute partial loss of motor, sensory, autonomic, and reflex (sphincter function below lesion) due to inflammaiton of spinal cord
-Consider mechanical compression before MS

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12
Q

What is a common presenting symptom of Acute Transverse Myelitis

A

L’Hermitte’s sign; flexing the neck forward sends shooting pain down the spine

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13
Q

What is the MC Sx causing unemployment in MS patients

A

Fatigue (physical and mental)

-R/o vitamin deficiency, anemia, and thyroid disease

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14
Q

What is “spasticity”

A

increased muscle tone and resistance to movement, mostly in posture muscles
Increase in muscle stiffness= you have to use more energy= fatigue

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15
Q

What cognitive dysfunction occurs in MS

A 
comprehension (use of speech) 
attention
memory
planning
problem solving
executive function
abstract reasoning
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16
Q

What types of pain are associated with MS

A

Primary (burning sensation)

Secondary (muscular pain d/t effects of MS)

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17
Q

What urinary Sx occur in MS

A

failure to store, empty, or both
Frequency
urgency
incontinence

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18
Q

MC bowel complaint with MS is

A

Constipation

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19
Q

How is the thyroid associated with bowel complaints

A 
Hypothyroid= constipation
Hyperthyroid= diarrhea
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20
Q

What is iternuclear ophthalmoplegia

A

When you ask the patient to look L or R, but the affected eye cant adduct
This causes diplopia

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21
Q

What are some key PE areas to hit for MS

A 
MMSE 
CN (VA, VF, EOM)- paresthesias and nystagmus  
Reflexes (asymmetry, babinski) 
Motor
Sensory
Gait (antalgic)
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22
Q

What are signs of spasticity

A

Bent wrist
Closed fist
Flexed elbow

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23
Q

What relieves spasticity

A

Baclofen (muscle relaxer)

24
Q

Important MS Ddx include

A 
Spinal cord neoplasm 
Encephaloyelitis
Sarcoidosis 
Transverse myelitis
B12 deficiency (spinal cord degeneration)
25
Q

What imaging should you get for MS

A

Brain/Spinal cord MRI w/ contrast

26
Q

Other diagnostic tests for MS are

A 
labs
CSF 
Evoked potentials 
\+/- Lyme serology, rheumatologic labs (ANA, RPR, ESR) 
B12, TSH, HIV, CXR
27
Q

What would LP with (+) MS show

A

IgG (>0.7) and oligoclonal bands (>2)

28
Q

What are the types of MS

A

PPMS (steady increase)
SPMS (initial RRMS with sudden decline, no remission)
PRMS (steady Increase w/ superimposed attacks)
RRMS (unpredictable attacks)

29
Q

Compare RRMS and PPMS outcomes

A

PPMS: 5 years, 50% will have cane
RRMS: 15 years, 50% will have cane

30
Q

What does the new MS criteria (McDonald) say

A

Dissemination in time (Sx 1+ months apart)

Dissemination in space (lesions in 2 diff. parts of CNS)

31
Q

How do you treat acute MS exacerbations

A

corticosteroids (high dose IV methylprednisone)

32
Q

What can you use to treat RRMS and SPMS

A 
IFN-B (avonex, Rebif) 
Glatiramir acetate (daily injection) 
Fingolimod 
Natilizumab 
Dimethyl fumirase
33
Q

What does the first dose of Fingolimod cause

A

bradycardia; do not give to patients with 2/3 degree AV block

34
Q

When should you give Natilizumab or Dimethyl fumirase

A

Only in aggressive/resistant RRMS, because of the increased risk of PML

35
Q

What meds treat fatigue in MS

A

Amantadine
Adderall
Modafinil

36
Q

What meds treat cognitive changes in MS

A

Aricept, Namenda, Exelon patch

37
Q

What meds treat depression in MS

A

SSRI

TCA

38
Q

How do you treat bladder problems in MS

A

Bladder training

Anti-spastic meds (Vesicare, Detrol, Ditropan)

39
Q

What meds can you use to treat constipation in MS

A 
Miralax
Metamucil
Citruce
Colace
increase fiber
40
Q

What is Myasthenia Gravis

A

Autoimmune disorder caused by antibody mediated block of neuromuscular transmission, causing skeletal muscle weakness
Progressive over weeks to months

41
Q

How does an autoimmune attack occur

A

Auto antibodies form against Nicotinic ACh receptors at NMJ of skeletal muscles

42
Q

Who is MG more prevalent in

A

Men 60-70

Women 30

43
Q

What do we always try to prevent in MG

A

Myasthenic crisis (need for intubation)

44
Q

How does MG present

A

painLESS specific muscle weakness affecting EOM, bulbar, or proximal limb muscles

45
Q

What is the MC presenting symptom in MG

A

Ptosis/Diplopia

46
Q

Other MG symptoms include

A

Dysphagia
Slurred speech
Difficulty chewing (NO liquid diet –>aspiration)
face/neck extension/flexion weakness

47
Q

What is the hallmark of MG

A

Muscles get weaker with repeat use (at end of day) and relieve with rest or ice therapy

48
Q

What can trigger or worsen MG

A 
warm weather 
Aminoglycosides in last 6-8 weeks (genta, tobra) 
Surgery
Vaccinations 
Menses
Incurrent illness
Pregnancy or post-partum
49
Q

What are common PE findings in MG

A

Facial muscle weakness (bilateral sagging)
corners of mouth droop (Myasthenic snarl)
cant whistle, suck, or blow

50
Q

What must you assess for ASAP

A

Respiratory failure! this is URGENT

51
Q

What is preferred MG diagnosis test

A

AChR antibody test

52
Q

What can cause a false (+) AChR test

A

Thymoma
SCC
RA treated with penicillamine
Lambert-Eaton Myasthenic syndrome

53
Q

What diagnostic studies are done for MG

A

CXR (thymoma)
MRI brain/orbit (IF strictly ocular Sx)
EKG

54
Q

What is the icepack test

A

put an ice pack over affected muscles (like eye lid) and Sx should improve- cold increases NM function

55
Q

How do you manage MG

A

Acetylcholinesterase inhibitor
Pyridostigmine for maintenance (or neostigmine)
IVIG
Plasmapheresis
long term immunosuppression (Prednisone, azathioprine)
thymectomy

56
Q

What is the prognosis of MG

A

near normal life w/ current treatments- low mortality

Slightly worse if >40, short Hx of disease, or you have a thymoma

57
Q

The only feared condition in MG is

A

Weakness in respiratory muscles

Nayla Foundations Exam 4 (15 decks)

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