Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neuro 3 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the definition of multiple sclerosis

A

chronic autoimmune inflammatory disease involving damage to the myelin in the brain and spinal cord

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

what is MS impacted by

A

genetics and environment

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

what is the typical patient population of MS

A

young child bearing aged females (30 years old) who are from areas above or below the 45 latitude

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

what are some triggers for MS

A
  • Sunshine
  • vitamin D
  • smoking
  • Epstein-Barr virus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are oligodendrocytes

A

cells that create myelin

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

what do astrocytes do

A

provide synaptic support, neuronal guidance and maintain blood brain barrier

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

what is the pathology of MS

A

1) B and T cells are activated through the autoimmune response.
2) they are able to cross the BBB due to a decreased permeability in the BBB and disfunction of astrocytes
3) T and B cells release antigens and interact with microglia releasing pro-inflammatory agents
4) antibody and cytokine release leads to inflammation and demylination
5) oligodendrocytes are unable to keep up with activation of the inflammatory response
6) neurodegeneration

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

what happens when the inflammation and autoimmune process stops?

A

the oligodendrocytes are able to remylinate again however there might be some irreversable axonal damage from the flare up

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

what does the loss of myelin lead to

A

fibrous astrocytes and gliosis (plaques) which is a hallmark sign of MS and is associated with loss of axonal function

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

what is gray matter damage associated with

A

clinical disability

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

what is white matter damage associated with

A

a rise in independency

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

what are the 5 types of MS

A

1) relapse- remitting
2) secondary progressive
3) primary progressive
4) progressive relapsing
5) benign/ clinical isolated syndrome of MS (30-70% of these people will go on to develop MS)

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

what is the most common progression of MS

A

1) preclinical phase (lasting several years)
2) relapsing-remitting phase (lasting 10-15 years)
3) secondary progressive phase (lasting 20+ years)

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

extended disability scale

A

0: no disability
1: no disability
2: min disabled
3: mod disabled
4: relatively severe disabled
5: disability impacts ADL
6: assistance required to work
7: restricted to a wheel chair
8: restricted to a bed or wheel chair
9: confined to bed

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

what range of the extended disability scale do people typically stop working

A

5-7

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

how to dx MS

A

diagnosis of exclusion and rule of 2s (2 lesions in 2 separate areas in the brain, SC or optic nerve at 2 different points in time)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what should be differental dx with MS

A
  • chronic LBP
  • Fibromyalgia
  • Cervical spondylosis
  • HNP
  • mitchondrial disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are dx tools to rule in or out MS

A
  • MRI to look at plagues
  • Lumbar puncture to look at increased protein levels with MS exasterbation
  • Visual Evoked Potential (VEP) to measure the electrical activity of the brain and optic nerve in response to stimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the initial signs of MS

A

1) 20 year old female
2) transient symptoms
3) fatigue
4) visual disturbances
5) paresthias, numbness, weakness, pins and needles and LBP
6) pain in bilateral LE with sudden and spontaneous electric shock

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

what are the S/S during an MS flare

A

1) S/S have to last longer then 24 hours
2) N/T
3) fatigue
4) visual changes
5) weakness
6) changes in gait
7) brain fog
8) tremors
9) incontinence

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

what is a pseudo exacerbation in MS

A

an exacerbation with no new damage lasting less then 24 hrs and resolve on its own. typically brought on by stress, heat, or exertion

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

what is the most common complaint of MS

A

fatigue

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

what is uhtoff phenomenon

A

over heating or heat intolerance

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

clinal presentation of MS

A

1) fatigue
2) heat intolerance
3) weakness and MSK pain
4) dysarthria
5) spasms and spasticity
6) ataxia
7) neuropathic pain: trigeminal and lhermittes sign
8) chronic neuropathic pain: dysesthesia and pruritis
9) gait dysfunction
10) decreased postural control
11) optic neuritis
12) B and B problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the 3 types of fatigue in MS
1) primary fatigue 2) indirect fatigue 3) neurologic fatigue
26
Causes of primary fatigue
damage to the axons in the brain and spinal cord that lead to muscular fatigue
27
Causes of indirect fatigue
through medication, sleep and depression
28
Causes of neurologic fatigue
spasms, weakness, heat exposure, energy failure
29
what are some factors that can increase symptoms of fatigue?
stress, mood and physcial activity
30
what are some factors that increase heat intolerance
physcial exertion, hot water or warm temp, fatigue note: it doens not increase the pathology of MS but does increase the symptoms such as fatigue, brian fog and pain
31
what are some things in the motor system that need to be evaluated in MS patients
1) weakness 2) ataxia 3) spasms/contractures 4) hypertonicity and spasticity 5) MSK pain and decreased ROM
32
what are some things in the neurological system that need to be evaluated in MS patients
1) acute neuropathic pain 2) trigeminal neuralgia 3) lhermittes sign 4) chronic neuropathic pain 5) pruritis all of this is caused by demyelination of the anterior lateral track
33
Sensation to evaluate in MS
1) visual: optic neuritis, double vision, CN2, color desaturation 2) somatosensory and proprioception (myelinated) 3) vestibular 4) neuropathic pain Note: pain will not be lost in this disease because they run on C fibers which is unmylinated
34
mobility issues to evaluation in MS
ataxic gait, gait that is impacted by spasticity, decreased sensation or cerebellar involvement
35
what are the 3 problems with MS and falling
1) delayed response in postural perturbations 2) increased body sway to quit standing 3) inability to move outside BOS note: all of this can lead to increased risk of fx with falls.
36
what percentange of MS patients have bowel problems
35-68%
37
what are the type of bowel issues seen in MS
1) fecal retention 2) incontinence 3) constipation
38
what percentage of MS patients have bladder problems
52-97%
39
what are the types of bladder problems seen in MS
1) urinary urgency 2) incontinence 3) detrusor overactive leading to an overactive bladder
40
what to evaluation in the cognition/psychosocial system in MS
1) depression 2) verbal fluency and memory 3) processing speed 4) executive functioning
41
what is the medical management for MS
disease modifying therapy to prevent new inflammatory lesions and prevent the development of secondary MS
42
what is the life expectancy for MS
usually pass 6 years earlier then the general population
43
what are some outcome measures for MS
- 12 item MS walking scale - Dizziness and handicap inventory - MS functional composite - MS impact scale - MS QOL - 25 foot TUG with cog task
44
modifiable risk factors for MS
smoking and exercise
45
triggers to avoid in MS
1) lack of sleep 2) low vitamin D 3) staying healthy 4) childbirth 5) heat 6) overactivity 7) stress
46
pt education for a relapse of MS
- UTIs are a common cause for relapse - decrease activity for 2 weeks - seek medical treatment if relapse is significant - relapses reduce cog function
47
MOA of Disease modifying therapies / Interferon B
decreases T cell activation and increase T cell adhesion and penetration of the BBB
48
PT multifaceted approach for MS direct role
1) functional balance and training 2) prevention 3) muscular exercise 4) cardio 5) fatigue education
49
what is the length of time for persistent chronic fatigue
over 6 weeks and 50% of the time have fatigue
50
what are some pt education strategies to avoid fatigue
- encourage a mid day nap - breathing activity - adjust activity levels - well balanced low fat diet - drink cool liquids
51
things to consider with exercise and MS
exercise does not increase disease process, early ex spares cognitive function, fit MS pts tend to have smaller and fewer lesions. Aerobic exercises increase BDNF which increases brain neuroplasticity and function.
52
what does motor learning do to oligodendrocytes
helps oligodendrocytes regenerate myelin
53
exercise recommendation for mild to mod MS according to AMJ
- 2-3 days of aerobic training (10-30 minutes at moderate intensity - 2-3 days of resistance training (1-3 sets of 8-15)
54
impact of aerobic exercise on hippocampas volume
study showed that hippocampual volume increases by 16.5% and memory increased by 53.5%
55
positioning for flexor spasticity
tummy time feet handing over the bed
56
positioning for extensor spasticity
sidelying position with hips and knees bent, place over a pillow between the legs and at the chest level.
57
benefits of functional strengthening in MS
eccentric exercise increases cortical excitability
58
why is balance so impacted in MS
decreased proprioception leading to impaired central integration, visual problems, vestibular issues, spasticity
59
strategies to improve balance in MS patients
- weighted vest to increase axial load - work on sensory based exercises - use whole body vibration to help decrease spasticity
60
is task based HIGT indicated for MS
yes but be aware of fatigue at high intensities.
61
what should be promoted in gait training for MS
short steps to keep COM level and increase time in SLS.
62
reccomdensations for MS and cardio for pts less then 7 EDSS
moderate intensity (40-60%) RPE 11-13 10-30 minutes 2-3x a week
63
when would it be a sign to provide an AD to an MS patient
- multipule stepping response - lack of an ankle strategy - loss of proprioception - slowed reaction speed
64
ADs used for MS
- straight cane progress to trecking poles - rollator - scooter
65
what would be an example of dynamic muscle overactivity
1) spasm 2) co-contraction 3) clonus 4) flexor withdraw
66
what would be an example of static muscle overactivity
spasticity and spastic dystonia
67
treatment options for generalized spasticity
oral meds
68
treatment options for focal spasticity
botox
69
treatment options for regional spasticity
baclonfen
70
what is the first line of treatment for MS
oral baclofen
71
what is the second line of treatment for MS
gabapentin
72
what is the last line of treatment for MS
CBD and THC
73
factors that increase spasticity
1) pressure ulcers 2) B and B dysfunction 3) infections 4) pain
74
what does the galileo do in treatment
provides continuous sensory information "resetting the spinal reflex", targets the muscle spindle by providing length and velocity, gives results for 20 minutes
75
what is the parameters for using TENS for spasticity treatment
100 hz and 0.3 ms pulse diration for 20 minutes a day for 4 weeks
76
what does TENS stimulate
the gait theory
77
benefits of prolonged stretch of a spastic muscle
lengthening reaction to have stretched muscles to relax thus inhibiting the muscle spindle
78
what are the two muscle fiber type in the muscle spindle
1a: reponds to velocity and rate 2: responds to the length of the tissue

Neuro 3 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions