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Y3 Neurology > Multiple Sclerosis > Flashcards

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
Q

what is the symptomatic management of lower urinary tract dysfunction in multiple sclerosis?

A

bladder drill
anti cholinergics
desmopressin
catheterisation

26
Q

name an anti-cholinergic drug

A

oxybutynin

27
Q

how is a moderate acute relapse of multiple sclerosis managed?

A

oral steroids over 5 days

28
Q

how is a severe acute relapse of multiple sclerosis managed?

A

admit

IV steroids

29
Q

when are patients given first line disease modifying therapy for MS?

A

when they have a relapse

30
Q

when are patients given second line disease modifying therapy for MS?

A

if first line failed or MS is very aggressive

31
Q

when are patients given third line disease modifying therapy for MS?

A

reserved for very few patients who have incredibly aggressive disease

32
Q

what is involved in first line disease modifying therapy for MS?

A

tecfidera

interferone beta and glatiramer acetate

33
Q

what is the first line treatment for relapsing remitting MS?

A

tecfidera

34
Q

what is involved in second line disease modifying therapy for MS?

A

monoclonal antibodies

oral fingolimod and cladribine

35
Q

what monoclonal antibodies can be given for MS?

A

tysabri
ocrevus
lemtrada

36
Q

what is involved in third line disease modifying therapy for MS?

A

stem cell transplant

Y3 Neurology (31 decks)

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