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Multiple Sclerosis Flashcards

1
Q

what type of disease is MS?

A

autoimmune

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2
Q

MS is mediated by what leukocyte?

A

T cell

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3
Q

what leukocyte directly destroys the myelin?

which tracts are particularly affected?

A

macrophage

white matter tracts

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4
Q

which tracts, white or grey are particularly affected?

why theses tracks and not the other?

A

white matter tracts

white tracts are myelin dominant

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5
Q

grey matter is predominantly composed of what stuff?

A

neural cell bodies

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6
Q

can you be asymptomatic?

A

yes

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7
Q

what is theorised as to why there is poorer recovery from acute relapses?

A

chronic low-level inflammation

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8
Q

which fibre tract when damaged in MS causes intranuclear ophthalmoplegia?

in which major structure is this tract located?

A

Medial longitudinal fasciculus

brainstem

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9
Q

what are the three patterns of disease in MS?

A

Relapsing-remitting

Secondary progressive

Primary progressive

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10
Q

how any pts will be primary progressive?

-% wise

A

15%

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11
Q

how any pts will be relapsing-remitting?
-% wise

how many of these cases will become secondary progressive?
-%wise

A

85%

60%

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12
Q

which gene is implicated?

A

HLA-DR2 gene

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13
Q

which infection is a risk factor?

A

EBV

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14
Q

which vitamin deficiency is a risk factor?

A

low vitamin D

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15
Q

what is the most common age range for diagnosis?

A

20-40

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16
Q

which gender is a risk factor?

A

female

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17
Q

which peoples are more effected?

A

northern Europeans

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18
Q

is southern latitude or northern latitude a risk factor?

A

northern latitude

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19
Q

which lifestyle factor is a risk factor?

A

Smoking

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20
Q

MS in first degree relative increase your chance of MS by how much?

A

20-40x

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21
Q

what is prevalence of MS in UK?

- as a %

A

0.18%

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22
Q

Demyelination of which two pathways leads to sensory loss?

A

spinothalamic

dorsal column pathway

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23
Q

hallmark feature seen on MRI?

24
Q

on MRI which lesions will enhance with contrast, new or old?

why is this important in diagnosis in MS?

A

new lesions

evidence of dissemination of lesions through space and time is needed to diagnose MRI

25
what is Uhthoff's?
symptoms worsen with ↑temp e.g. after hot bath
26
what urological symptoms are there? | -2
bladder dysfunction (incontinence) Erectile dysfunction
27
what ophthalmological symptoms are there?
blurred vision red desaturation optic neuritis
28
what does Internuclear ophthalmoplegia look like?
inability to move both your eyes together when looking to the side
29
will there be UMN or LMN signs?
UMN
30
MS pt feel electric shock run down neck, back, and sometimes limbs. Triggered by neck flexion often. what is this sign called?
Lhermitte’s phenomenon
31
what colour can MS pts sometimes not see?
red
32
on ophthalmoscope what sign is seen?
pale optics disk
33
on doing swinging light tests what sign is seen?
relative afferent pupillary defect
34
on MRI, | lesions will be high signal on T1 or T2?
T2
35
hallmark feature on LP?
oligoclonal bands
36
which criteria used to diagnose? describe this criteria?
McDonald Criteria ≥ 2 relapses & either o objective clinical evidence of 2 or more lesions or o objective clinical evidence of one lesion with reasonable history of previous relapse.
37
1st line treatment for relapse? how long do you give this drug for?
methylprednisolone 5 days
38
2nd line treatment for acute relapse?
Plasma exchange (PLEX)
39
which monoclonal antibodies can be used for maintenance? | -2
alemtuzumab or natalizumabBeta-Interferon
40
which immunomodulators can be used to maintain MS remission? | -2
Glatiramer acetate Fingolimod
41
which interferon can be used to maintain MS remission?
beta interferon
42
list all drugs that can be used for maintenance in MS? | -4
beta interferon alemtuzumab natalizumab Glatiramer acetate Fingolimod
43
MS patient has spasticity. what drugs can be used to treat? -2 named e.g. what non-drug option is there?
baclofen or gabapentin physiotherapy
44
MS patient has depression. what drug is used to treat?
amitriptyline
45
MS patient has oscillopsia. what is 1st line drug?
gabapentin
46
MS patient has fatigue. what non-drug option is there for management? provided there is no anaemia or thyroid problem etc, what drug option is used?
CBT amantadine
47
MS patient has bladder dysfunction. on US there is significant residual volume. what is 1st line treatment?
intermittent self-catheterisation
48
MS patient has bladder dysfunction. on US there is insignificant residual volume. what is drug is used for this? what type of drug is this?
oxybutynin anti-cholinergic
49
what type of drug is baclofen? what effect does it have on muscles?
antispasmodic muscles relax
50
what type of drug is Oxybutynin? explain moa of this drug in how it helps MS?
anticholinergic ACh sends signals to brain triggering abnormal bladder contractions, oxybutynin will block ACh.
51
how many MS cases have normal CSF? | -% wise
10-20%
52
moa of Alemtuzumab?
hits on lymphocyte CD52 receptor causing lymphocyte lysis
53
moa of Fingolimod?
Stops lymphocytes leaving lymph node.
54
what hallmark sign is seen on FLAIR MRI?
Dawson's fingers.
55
list complications of MS? | -8
* Fatigue * UTIs * Incontinence * Constipation * Depression * Vision impaired (Oscillopsia) * Mobility impaired/spastic gait * Erectile dysfunction
56
which contrast do you use to look for new lesions in MRI? how will these new lesion appear visually?
Gadolinium bright
57
how new must lesion be for a Gadolinium MRI to show it?
<8 weeks

Neurology (40 decks)

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