Multiple Sclerosis Flashcards

1
Q

what is the pathology behind multiple sclerosis?

A

demyelination of axons

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2
Q

which sex is more commonly affected by multiple sclerosis?

A

females

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3
Q

when does the initial presentation of multiple sclerosis usually occur?

A

30’s and 40’s

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4
Q

what are some symptoms of pyramidal dysfunction seen in multiple sclerosis?

A

increased tone
spasticity
weakness

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5
Q

what parts of the body can be affected by pyramidal dysfunction in multiple sclerosis?

A

extensors of the upper limbs

flexors of the lower limbs

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6
Q

what eye condition can affect patients with multiple sclerosis?

A

optic neuritis

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7
Q

how does optic neuritis present?

A

painful visual loss that gets worse over 1-2 weeks

may have RAPD

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8
Q

what sensory symptoms can be seen in multiple sclerosis?

A
pain 
paraesthesia 
dorsal column loss 
numbness 
trigeminal neuralgia
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9
Q

what symptoms can be caused by dorsal column loss?

A

problems with proprioception and vibration sense

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10
Q

what lower urinary tract symptoms can be associated with multiple sclerosis?

A
frequency 
nocturia 
urgency 
urge incontinence 
retention
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11
Q

what symptoms of cerebellar dysfunction can be seen in multiple sclerosis?

A

dysarthria
ataxia
nystagmus
intention tremor

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12
Q

what cranial nerves can be affected by brainstem dysfunction in multiple sclerosis and what symptoms can this cause?

A

CN VI - diplopia

CN VII - facial weakness

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13
Q

what causes internuclear ophthalmoplegia?

A

damage to the medial longitudinal fasciculus

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14
Q

what disease can internuclear ophthalmoplegia be associated with?

A

multiple sclerosis

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15
Q

how can internuclear ophthalmoplegia present?

A

distortion of vision
diplopia
nystagmus
lid lag

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16
Q

how is multiple sclerosis diagnosed?

A

clinical diagnosis based on exclusion, presence of a clinical episode suggestive of demyelination and symptoms disseminated in time and place

17
Q

how can multiple sclerosis lesions be visualised?

A

T2 weighted MRI

lesions appear very bright

18
Q

what can be seen when CSF is investigated in multiple sclerosis?

A

oligoclonal bands

their absence does not rule out multiple sclerosis

19
Q

how is a mild acute relapse of multiple sclerosis managed?

A

symptomatic treatment depending on the patients individual symptoms

20
Q

what is the symptomatic management of pyramidal dysfunction in multiple sclerosis?

A

physio
anti spasmodics
botox
intrathecal baclofen

21
Q

name two anti-spasmodic drugs

A

baclofen

tizanidine

22
Q

what is the symptomatic management of sensory symptoms in multiple sclerosis?

A

anti-convulsants
anti-depressants
TENS machine
acupuncture

23
Q

what treatment can be used if MS patients have very resistant pain?

A

lignocaine infusion

24
Q

name an anti convulsant drug

A

gabapentin

25
what is the symptomatic management of lower urinary tract dysfunction in multiple sclerosis?
bladder drill anti cholinergics desmopressin catheterisation
26
name an anti-cholinergic drug
oxybutynin
27
how is a moderate acute relapse of multiple sclerosis managed?
oral steroids over 5 days
28
how is a severe acute relapse of multiple sclerosis managed?
admit | IV steroids
29
when are patients given first line disease modifying therapy for MS?
when they have a relapse
30
when are patients given second line disease modifying therapy for MS?
if first line failed or MS is very aggressive
31
when are patients given third line disease modifying therapy for MS?
reserved for very few patients who have incredibly aggressive disease
32
what is involved in first line disease modifying therapy for MS?
tecfidera | interferone beta and glatiramer acetate
33
what is the first line treatment for relapsing remitting MS?
tecfidera
34
what is involved in second line disease modifying therapy for MS?
monoclonal antibodies | oral fingolimod and cladribine
35
what monoclonal antibodies can be given for MS?
tysabri ocrevus lemtrada
36
what is involved in third line disease modifying therapy for MS?
stem cell transplant