Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals: Medicine > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Define multiple sclerosis

A

chronic and progressive autoimmune disorder characterised by demyelination in the central nervous system (CNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What structures comprise the CNS

A

Brain

Brainstem

Spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What process causes the activatin of the immune cells against the myelin in the CNS leading to demyelination

A

Inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the hallmark of MS

A

Demyelination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

multiple sclerosis is an autoimmune disorder in which the immune cells act against what in the CNS

A

Myelin leading to demyelination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the typical age of diagnosis of multiple sclerosis

A

20-40 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Multiple sclerosis is more commonly seen in what gender?

A

Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name a gene that has been linked as a risk factor of Multiple sclerosis

A

HLA DRB1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name an infection that has been linked to the development of Multiple sclerosis

A

Epstein-Barr virus (EBV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name some of the risk factors multiple sclerosis

A

Age - commonly diagnosed in 20-40

Gender - more common in females

Genetic component

Geographic latitude: increase incidence in the greater distance north or south

Sunlight exposure

Epstein–Barr virus (EBV) e.g. glandular fever

Low vitamin D

Smoking

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name a protective factor of multiple sclerosis

A

Symptoms tend to improve in pregnancy and in the postpartum period.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name the cell that produces myelin in the peripheral nervous system

A

Schwann cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name the cell that produces myelin in the central nervous system

A

Oligodendrocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Multiple sclerosis typically affects the:

a) CNS
b) PNS
c) Both

A

a) CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What causes the damage to the myelin (demyelination) in multiple sclerosis

A

Inflammation and infiltration of immune cells around the myelin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why do symptoms early in the disease resolve whilst in late multiple sclerosis they dont?

A
  • In early disease, re-myelination can occur and symptoms can resolve
  • In the later stages, re-myelination is incomplete and the symptoms gradually become more permanent.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define clinical isolated syndrome

A
  • Referred as the first episode of suspected MS
  • MS cannot be diagnosed on one episode as the lesions have not been “disseminated in time and space”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why cant multiple sclerosis be diagnosed on one episode

A

lesions have to “disseminated in time and space”

i.e. the symptoms change over time (as different nerves are affects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Multiple sclerosis can be categorised depending on the disease patterns.

Name the 3 types of MS disease patterns

A

Relapsing-remitting

Primary progressive

Secondary progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common disease pattern for multiple sclerosis

A

Relapsing-remitting (90% of cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the characteristics of the relapsing-remitting multiple sclerosis pattern

A

Characterised by episodes of disease and neurological symptoms followed by recovery (remissions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the characteritics of the secondary progressive multiple sclerosis disease pattern

A

Characterised by a relapsing-remitting phenotype initially but eventually there is progressive worsening of symptoms with incomplete remissions

Disease course changes with gradual, sustained worsening in neurological function.

Relapses may still occur but without remission.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What percetange of patients with relapse-remitting multiple sclerosis will develop secondary progressive pattern within 15 years since onset

A

50% of patients with relapse-remitting phenotype will develop secondary progressive pattern within 15 years of onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Secondary progressive multiple sclerosis pattern has a close relationship with another disease pattern - in case over 50% of the other disease pattern ultimately develop secondary progressive pattern.

Name the other disease pattern

A

Remitting-remission multiple sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe the characteristics of the primary progressive multiple sclerosis disease progression

A

Characterised by worsening of disease and neurological symptoms from the onset of diagnosis

May have periods where disease is not active or non-progressive, however there is no relapses or remission

26
Q

What multiple sclerosis disease pattern has:

Relapse without remission

A

Secondary progressive multiple sclerosis

27
Q

What multiple sclerosis disease pattern has:

No Relapse and no remission

A

Primary progressive multiple sclerosis

28
Q

What other disease pattern may patients with relapse-remittin develop as their disease progresses

A

Secondary progressive multiple sclerosis

29
Q

Name this multiple sclerosis disease pattern

A

Secondary progressive multiple sclerosis

30
Q

Name this multiple sclerosis disease pattern

A

Primary progressive multiple sclerosis

31
Q

Name this multiple sclerosis disease pattern

A

Relapsing-remitting multiple sclerosis

32
Q

Define the term: relapse period

A

refers to a period of new symptoms

33
Q

Define the term: remission period

A

Remission follows a relapse, a period with no or few symptoms – the symptoms they experience at this stage is residual damage

34
Q

How long will MS symptoms tend to last at first presentation

A

Symptoms tend to last days-weeks and then improve

35
Q

Multiple sclerosis (MS) is multifocal and therefore there is large variability of symptoms – depends on the plaque location within the CNS.

Name the two most common clinical manifestations of MS

A

Optic neuritis

Lethargy

36
Q

The clinical manifestations of multiple sclerosis is broadly grouped into 4 groups.

Name these groups

A

o Visual

o Motor and coordination

o Sensory and autonomic

o Cognitive and psychological

37
Q

Optic neuritis involves the demyelination of what structure

A

the optic nerve

38
Q

Optic neuritis involves the demyelination of the optic nerve.

What is the result of this?

A

Loss of vision in one eye

39
Q

Sixth nerve palsy is a potential symptom of multiple sclerosis.

What two problems can this cause

A

Internuclear ophthalmoplegia

Conjugate lateral gaze disorder

40
Q

Internuclear ophthalmoplegia can occur as a consequence of a sixth nerve palsy.

What are the clinical features of Internuclear ophthalmoplegia

A

blurry vision

Diplopia (double vision)

41
Q

Conjugate lateral gaze disorder can occur as a consequence of a sixth nerve palsy.

Describe what is affected in patients with this disorder

A

The affected eye will not able abduct

i.e. when looking laterally in the direction of the affected eye, the unaffected eye will adduct (move towards the nose) but the affected eye will not abduct (move laterally)

42
Q

Name some of the Motor and Co-ordination clinical manifestations of multiple sclerosis

A

Progressive paraparesis i.e. paralysis of both legs

Upper motor neurone signs (spasticity, reduced power, hyper-reflexia)

Ataxia – lack of muscle coordination

43
Q

Name some of the sensory and autonomic clinical manifestations of multiple sclerosis

A

Paraesthesia i.e. pins and needles

Pain

Numbness

Uhthoff phenomenon – worsen of vision following rise in body temp.

44
Q

Uhthoff phenomenon is a potential clinical manifestation of multiple sclerosis.

Describe the phenomenon

A

Worsen of vision following rise in body temp.

45
Q

Multiple sclerosis can have what type of signs:

a) Upper motor signs
b) Lower motor signs
c) Both
d) Neither

A

a) Upper motor signs

46
Q

Multiple sclerosis cannot be diagnosed on one episode as the lesion have to disseminated in time and space.

Diagnosis is based on at least two of the following criteria

A

Clinical history/examination

Imaging features (usually MRI)

Oligoclonal bands in CSF

47
Q

What is the name of the diagnostic criteria for the diagnosis of MS based on MRI findings and clinical presentation

A

McDonald criteria

48
Q

McDonald criteria is a diganostic criteria for the diagnosis of what condition

A

for the diagnosis of MS based on MRI findings and clinical presentation

49
Q

What is the imaging modality that is useful for the diagnosis and surveillance of MS (to assess response to treatment)

A

MRI

50
Q

What is the gold standard imaging modality for multiple sclerosis

A

MRI

51
Q

MRI is the most useful imaging modality for multiple sclerosis.

What aspects of the multiple sclerosis is it useful for

A
  • Diagnosis - can identify the demyelinating lesions
  • Surveillance to assess response to treatment
52
Q

Name the two hallmark features of multiple sclerosis on MRI

A

Plaques of demyelination

Eventual axonal loss

53
Q

Lumbar puncture is important in investigating multiple sclerosis.

What are you trying to detect in the CSF

A

oligoclonal bands

54
Q

What are oligoclonal bands and what do their presence indicate?

A

Oligoclonal bands are bands of immunoglobulins

They indicate the presence of an autoimmune response in the CNS

55
Q

Oligoclonal bands are very sensitive for multiple sclerosis although they can also be found in other auto-immune and infectious conditions.

Give an example of another condition in which they are found in

A

Lyme disease, SLE.

56
Q

Multiple sclerosis patients should be under the care of a multidisciplinary MS team. There is no cure for MS however the aim of management is three fold.

Name these 3 parts of the management of ms

A

Disease modification therapies

Treat acute relapses

symptomatic relief as symptoms develop.

57
Q

What is the aim of management with disease modification therapies in multiple sclerosis

A

Aim to decrease the number of relapses and slow disease progression

58
Q

Give an example of a disease modification therapies used in the management of multiple sclerosis

A

First-line injectables e.g. beta-interferon and glatiramer

New oral agents e.g. dimethyl fumarate, teriflunomide and fingolimod

Biologics e.g. natalizumab and alemtuzumab.

59
Q

How are acute relapses of multiple sclerosis managed

A
  • High dose steroids e.g., methylprednisolone
    • 500mg orally daily for 5 days
    • 1g intravenously daily for 3–5 days where oral treatment has failed previously or where relapses are severe
60
Q

Why are steroids only used to treat acute relapse and not used in the long term management of multiple sclerosis

A

Steroids shorten the duration of a relapse but they do not alter the degree of recovery (i.e. whether a patient returns to baseline function)

61
Q

A part of the management of multiple sclerosis is to provide symptomatic relief as symptoms develop.

Give an example of one which symptom and its management

A

Exercise to maintain activity and strength

Neuropathic pain can be managed with medication such as amitriptyline or gabapentin

Finals: Medicine (91 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions