Multiple Sclerosis

Question 1

general definition of MS

Answer 1

autoimmune disease by demyelination of CNS - white matter

great crippler of young adults

Question 2

epidemiology of MS

Answer 2

20-40 yo

females

white and african americas more - colder countries

15 yo below will follow the prevalence of migrated country

Question 3

etiology of MS

Answer 3

idiopathic

autoimmune

epstein-barr virus - most common

genetic predisposition

Question 4

pathophysiology of MS

Answer 4

infection like epstein-barr willa attack white matter like myelin

then once sira na glial cells and oligodendrocytes will remyelinate

tas cycle until mapalitan na ng astrocyte tas di na kaya mag remyelinate

hence has periods of relapsing and remyelination

Question 5

most commonly involved structure in ms

Answer 5

optic nerves - most common bcs madami WM; hence optic neuritis and blurring is initial sx

PVM

spinal cord

cerebellar peduncles

Question 6

what are the types of MS based on disease course

Answer 6

relapsing remitting

primary progressive

secondary progressive

progressive relapsing

Question 7

discuss relapsing remitting

Answer 7

most ccomon

alternate of total remission and attacks with same sx

intensity lang nag iiba di yung sx

Question 8

discuss primary progressive

Answer 8

steady progression with no remission periods

add ng add of sx

Question 9

discuss secondary progressive

Answer 9

RRMS then PP = SP

Question 10

discuss progressive relapsing

Answer 10

dec intensity of sx lang not total remission then mag add ng bago

steady padin pag progress tas may spikes lang

Question 11

exacerbating factors of MS

Answer 11

fatigue and uthoff’s syndrome

Question 11

discuss fatigue in MS

Answer 11

most disabling sign

bawal ma fatigue kasi mag kaka attack

so in tx dapat sabihin if malapit na mapagod si pt

Question 12

discuss uthoff’s syndrome in MS

Answer 12

adverse reaction to heat: >29°C

put pt near aircon if not mag ka attack

Question 13

cardinal sx of MS

Answer 13

SIN

scanning speech or dysarthria

intention tremor

nystagmus

pwede din charcot’s triad and other neuro sx

Question 14

sensation other clinical manifestations

Answer 14

paresthesia

pain

trigemina neuralgia

proxysmal limb pain

hyperpathia

migraines

Question 15

visual other clinical manifestations

Answer 15

optic neuritis

scotoma

marcus gunn pupil

nystagmus

diplopia

Question 16

motor other clinical manifestations

Answer 16

spasticity

Question 17

balance and coordination other clinical manifestations

Answer 17

cerebellar probs

dyssenergia

dysdiadochokinesia

Question 18

cognition other clinical manifestations

Answer 18

cerebral prob

impaired attention and concentration

impaired memory

impaired executive function

slowed processing

Question 19

affectation other clinical manifestations

Answer 19

euphoria

depression

bipolar

Question 20

autonomic other clinical manifestations

Answer 20

can affect spinal cord

bladder and bowel dysfunction

sexual dysfunction

Question 21

mcdonald criteria

Answer 21

2 or more lesions and attack - definite MS

2 attack and 1 lesion - probable

1 attack and 2 lesion - probable

1 attack and lesion - possible

Question 22

different pathologic lesions of MS

Answer 22

T1: cell mediated destruction of myelin

T2: cell mediated destruction of myelin c immunoglobulin

T3: cell death of oligo

T4: neurodegen of oligo

Question 23

most common pathologic lesion

Answer 23

T2

Question 24

least common pathologic lesion

Answer 24

T4

Question 25

kurtzke expanded disability status scale scoring

Answer 25

0.5 improvement = poor prog >1 improvement = good prog higher score = worse