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Neurology > Multiple Sclerosis > Flashcards

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?

A

plaques

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
Q

what is Uhthoff’s?

A

symptoms worsen with ↑temp e.g. after hot bath

26
Q

what urological symptoms are there?

-2

A

bladder dysfunction (incontinence)

Erectile dysfunction

27
Q

what ophthalmological symptoms are there?

A

blurred vision

red desaturation

optic neuritis

28
Q

what does Internuclear ophthalmoplegia look like?

A

inability to move both your eyes together when looking to the side

29
Q

will there be UMN or LMN signs?

A

UMN

30
Q

MS pt feel electric shock run down neck, back, and sometimes limbs. Triggered by neck flexion often.

what is this sign called?

A

Lhermitte’s phenomenon

31
Q

what colour can MS pts sometimes not see?

A

red

32
Q

on ophthalmoscope what sign is seen?

A

pale optics disk

33
Q

on doing swinging light tests what sign is seen?

A

relative afferent pupillary defect

34
Q

on MRI,

lesions will be high signal on T1 or T2?

A

T2

35
Q

hallmark feature on LP?

A

oligoclonal bands

36
Q

which criteria used to diagnose?

describe this criteria?

A

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
Q

1st line treatment for relapse?

how long do you give this drug for?

A

methylprednisolone

5 days

38
Q

2nd line treatment for acute relapse?

A

Plasma exchange (PLEX)

39
Q

which monoclonal antibodies can be used for maintenance?

-2

A

alemtuzumab or natalizumabBeta-Interferon

40
Q

which immunomodulators can be used to maintain MS remission?

-2

A

Glatiramer acetate

Fingolimod

41
Q

which interferon can be used to maintain MS remission?

A

beta interferon

42
Q

list all drugs that can be used for maintenance in MS?

-4

A

beta interferon
alemtuzumab natalizumab
Glatiramer acetate
Fingolimod

43
Q

MS patient has spasticity.

what drugs can be used to treat?
-2 named e.g.

what non-drug option is there?

A

baclofen or gabapentin

physiotherapy

44
Q

MS patient has depression.

what drug is used to treat?

A

amitriptyline

45
Q

MS patient has oscillopsia.

what is 1st line drug?

A

gabapentin

46
Q

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?

A

CBT

amantadine

47
Q

MS patient has bladder dysfunction.

on US there is significant residual volume.

what is 1st line treatment?

A

intermittent self-catheterisation

48
Q

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?

A

oxybutynin

anti-cholinergic

49
Q

what type of drug is baclofen?

what effect does it have on muscles?

A

antispasmodic

muscles relax

50
Q

what type of drug is Oxybutynin?

explain moa of this drug in how it helps MS?

A

anticholinergic

ACh sends signals to brain triggering abnormal bladder contractions, oxybutynin will block ACh.

51
Q

how many MS cases have normal CSF?

-% wise

A

10-20%

52
Q

moa of Alemtuzumab?

A

hits on lymphocyte CD52 receptor causing lymphocyte lysis

53
Q

moa of Fingolimod?

A

Stops lymphocytes leaving lymph node.

54
Q

what hallmark sign is seen on FLAIR MRI?

A

Dawson’s fingers.

55
Q

list complications of MS?

-8

A
  • Fatigue
  • UTIs
  • Incontinence
  • Constipation
  • Depression
  • Vision impaired (Oscillopsia)
  • Mobility impaired/spastic gait
  • Erectile dysfunction
56
Q

which contrast do you use to look for new lesions in MRI?

how will these new lesion appear visually?

A

Gadolinium

bright

57
Q

how new must lesion be for a Gadolinium MRI to show it?

A

<8 weeks

Neurology (40 decks)

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