MS pt. 2

Question 1

relapsing remitting MS (RRMS)

Answer 1

clear defined episodes of neurologic function followed by partial/complete recovery, with periods of time btw that pt’s are clinical free of disease progression

Question 2

secondary progressive MS (SPMS)

Answer 2

can progress to this

initially presents as RR period followed by a steady worsening of neurologic fxn, with or without relapses

Question 3

what do remissions look like with SPMS

Answer 3

minor or can have plateau
continue to get worse
can get missed

Question 4

primary progressive MS (PPMS)

Answer 4

continuous worsening from initial onset without distinct relapses or remission

may have occasional plateaus and temporary minor improvements

Question 5

acute exacerbation treatment

Answer 5

immunosuppressant drugs
prednisone, methylprednisone, adrenocorticotropic hormone (ACTH)

Question 6

what drugs are disease modifying

Answer 6

interferon drugs
copaxone
tysabri
novantrone

Question 7

what do disease modifying drugs do

Answer 7

reduce frequency and severity of:
clinical attacks
reduce development of lesion sites
slow down the progression of disability

Question 8

what do interferon drugs do

Answer 8

slow progression and decrease symptoms

Question 9

side effects of interferon drugs

Answer 9

flu like symptoms
depression
abdominal pain
injxn site pain
leukopenia

Question 10

dosage for interferon drugs

Answer 10

daily
3x week
or weekly

Question 11

dosage for copaxone

Answer 11

daily subcutaneous injxn

Question 12

how does copaxone work

Answer 12

synthetic protein designed to mimic effects of myelin protein

Question 13

side effects of copaxone

Answer 13

flu symptoms
N/V
joint pain
visual disturbances
weakness
edema in hands and feet

Question 14

what systems does the expanded disability status scale look at

Answer 14

pyramidal
cerebellar
brainstem
sensory
bowel/bladder
visual
cerebral
other neurologic findings

Question 15

normal to mild disability for EDSS

Answer 15

0-3.5

Question 16

mild to moderate disability for EDSS

Answer 16

4-5.5

Question 17

mod to severe disability for EDSS

Answer 17

6-7.5

Question 18

severe disability with restriction to bed or WC for EDSS

Answer 18

8-9.5

Question 19

EDSS 0-4.5 clinical symptoms

Answer 19

no symptoms to mild to mod:

fatigue
unsteadiness/imbalance
sensory changes
mild walking impairments
reduced visual acuity
bowel/bladder symptoms
altered mood state
cog impairment

Question 20

EDSS 0-4.5 neurologic impairments

Answer 20

ranging from normal neurologic exam to mild-to-mod impairments in:

proprioception
cerebellar fxn
vision
muscle strength/tone/endurance
bladder fxn
cognition

Question 21

EDSS 0-4.5 functional limitations

Answer 21

ranging from no limitations to limited:

endurance
unsteadiness
impaired information processing and memory

Question 22

EDSS 5-6.5 symptoms

Answer 22

progression of any or all symptoms seen in 0-4.5

Question 23

EDSS 5-6.5 neurologic impairments

Answer 23

any symptoms mentioned with EDSS 0-4.5 plus:

worsening gait and UE coordination

Question 24

EDSS 5-6.5 functional limitations

Answer 24

limited walking distance 20-200m
falls
inability to safely complete dual motor/cognitive tasks
adaptive equipment at work/home
compensatory strategies
mobility aids
challenging transfers
requires assistance from support partner for more complex daily activities

Question 25

EDSS 7-9 symptoms

Answer 25

continued worsening gait of all symptoms mentioned with other levels

Question 26

EDSS 7-9 neurologic impairments

Answer 26

continued worsening symptoms mentioned with other levels

Question 27

EDSS 7-9 functional limitations

Answer 27

gait - 10ft w walker
transfers - minimal assist to total
bed mobility - minimal assist to total
seated balance - independent to total assist
standing balance - ind w bilateral support to unable to stand unaided