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724: Medical Lectures > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

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USMLE® Step 1 flashcards
1
Q

What part of the CNS does MS attack?

A

the myelin of the white matter

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2
Q

Is MS considered an upper or lower motor neuron lesion?

A

upper

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3
Q

MS is characterized by reactive gliosis, what 2 things does this lead to?

A
  • scarring

- disturbances in the transmission of action potentials

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4
Q

MS usually affects what age group?

A

young adults (usual onset less than 55)

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5
Q

MS is most common in what type of people?

A

Those with western European lineage

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6
Q

Describe MS incidence in reference to the equator

A

Usually affects people who reside in temperate locations away from the equator

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7
Q

No population that is considered a high risk of developing MS lives within __ degrees north or south of the Equator

A

40

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8
Q

What genetic component appears to be associated with the susceptibility of MS?

A

the alleles of interleukin-2 and interleukin-7 alpha receptors

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9
Q

Where are the 2 alpha receptors located?

A

on the cell membranes of B and T lymphocytes

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10
Q

What are the 5 initial signs and symptoms of MS?

A
  • Weakness
  • Numbness
  • Optic neuritic diplopia (double vision)
  • Dysequilibrium
  • Sphincter disturbance (urinary urgency)
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11
Q

What 3 UMN signs are found in patients with MS?

A
  • Babinski sign
  • Hyperreflexia
  • Spasticity
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12
Q

What are the 4 types of MS?

A
  • Relapsing-remitting MS (RRMS)
  • Secondary progressive MS (SPMS)
  • Progressive-relapsing MS (PRMS)
  • Primary Progressive MS (PPMS)
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13
Q

What type of MS is the most common?

A

relapsing-remitting

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14
Q

Relapsing-remitting affects nearly __% of all patients

A

70

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15
Q

What is relapsing-remitting MS characterized by?

A

Increases in neurological dysfunction (relapse), followed by periods without disease progression (remission) in which the patient can achieve full recovery

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16
Q

__% of patients with RRMS go on to develop secondary progressive MS

A

80

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17
Q

Describe SPMS

A

The relapse-remitting course is followed by progression of symptoms with or without relapses, remissions or plateaus

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18
Q

Describe PRMS

A

Symptoms get progressively worse from onset and relapses may or may not resolve with full recovery

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19
Q

Primary Progressive MS occurs about __% of the time

A

10

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20
Q

Describe PPMS

A

There is continuous worsening of function from onset and there is no distinct relapses or remissions

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21
Q

What are 2 factors that may precipitate or trigger exacerbations?

A
  • infection

- pregnancy

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22
Q

What imaging technique is most useful for diagnosing MS?

A

MRI

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23
Q

What do T1-weighted MRIs show?

A
  • hypointense (“black holes”) areas that represent axonal damage
  • hyperintense (bright) lesions
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24
Q

What can Gadolinium-enhanced T1-weighted highlight?

A

inflammation with breakdown of the blood-brain barrier, which helps identify new lesions

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25
Q

What do T2-weighted MRIs display?

A

the total number of lesions

26
Q

What do lesions look like on a T2-weighted MRI?

A

high signal intensity areas

27
Q

Can a definitive diagnosis of MS be based solely on lab findings?

A

No

28
Q

Can MS be properly diagnosed if there is evidence of only a single lesion in the CNS?

A

No

29
Q

What type of studies have been used to detect subclinical involvement of the visual, brainstem auditory, and somatosensory pathways?

A

Electrocerebral responses (aka evoked potentials)

30
Q

What are the 3 CSF abnormalities found in MS patients?

A
  • mild lymphocytosis
  • slightly increased protein concentration
  • elevated immunoglobulin G (IgG)
31
Q

Are IgG bands specific to MS?

A

no

32
Q

When can MS be diagnosed?

A

When there are 2 or more different regions of central nervous system (brain, spinal cord, or optic nerves) that have been affected at different times

33
Q

What special procedure produces high resolution cross-sectional and three dimensional images of the retina, cornea and anterior chamber of the eye?

A

Optical Coherence Tomography

34
Q

What do visual evoked potentials do?

A

Detect impaired transmission along optic nerve pathways

35
Q

Are impaired VEPs specific to MS?

A

no, they should be used in collaboration with laboratory and clinical symptoms

36
Q

Under what 2 circumstances is imaging diagnostic of MS?

A
  • if a gadolinium-enhancing lesion is present at least 3 months after an initial clinical event
  • if a new T2 lesion is found at any time compared with a baseline scan obtained at least 30 days after initial clinical event
37
Q

What are the 4 criteria for MRI brain abnormality?

A
  • At least one gadolinium-enhancing lesion or nine T2 hyperintense lesions if no enhancing lesion
  • One or more infratentorial (or spinal cord) lesions
  • One or more juxtacortical lesions
  • At least three periventricular lesions
38
Q

How many of the 4 MRI abnormalities must be present in order to diagnose?

A

3 of the 4

39
Q

In patients with a single clinical event who do not satisfy criteria for MS, a diagnosis of what is given?

A

Clinically isolated syndrome (CIS)

40
Q

What are patients with clinically isolated syndrome (CIS) treated?

A

Beta-interferon or glatiramer acetate therapy to try and delay the progression to MS

41
Q

What role do medications play in treating MS?

A

They can limit the recurrence of attacks and slow the progression

42
Q

__% of patients are without significant disability 10 years after onset

A

50

43
Q

What type of therapy is given first?

A

IV (typically methylprednisolone 1g/day for 3 days)

44
Q

What role do corticosteroids play in treating MS?

A

Help to speed up recovery from acute relapses, however the magnitude of recovery shows no difference

45
Q

What reduces the frequency of exacerbations in patients with relapsing-remitting or secondary progressive MS?

A
  • Indefinite treatment with beta-interferon

- subcutaneous administration of glatiramer

46
Q

What drug reduces the relapse rate when given intravenously but is also associated with an increased risk of the development of progressive multifocal leukoencephalopathy?

A

Natalizumab

47
Q

True or False

Natalizumab can be used in combination with beta-interferon, glatiramer acetate, or other immune-modifying therapies

A

False

48
Q

What drug reduces the relapse rate in MS?

A

Fingolimod

49
Q

What drug is limited by liver toxicity in some patients?

A

Teriflunomide

50
Q

When should Alemtuzumab be used?

A

if asymptomatic progressive multifocal leukoencephalopathy develops from Natalizumab use

51
Q

What is an effective FDA-approved drug to treat fatigue associated with MS?

A

modafinil

52
Q

What drug is effective at improving timed gait in MS?

A

dalfampridine

53
Q

Patients on interferon beta-1a drugs are more susceptible to what kinds of disorders?

A

depression or suicidal behaviors

54
Q

What is a common cause of pain in MS?

A

Musculoskeletal strain and joint malalignment caused by weakened muscles

55
Q

What has been proven to improve function while lessening disability, and enhancing the patients’ quality of life?

A

exercise

56
Q

When should exercise sessions be scheduled and why?

A

in the morning before fatigue sets in and when core body temp is the lowest

57
Q

MS patients have been known to only be able to achieve __-__% of their age predicted max HR

A

75-85

58
Q

Exercise intensity should be limited to __-__% of peak HR or _–__% of peak VO2

A

60-75

50-65

59
Q

What 2 things can help fight off spasticity?

A

increased flexibility and cryotherapy

60
Q

Overall what is the basis of physical therapy?

A

Always be functional and limit fatigue

724: Medical Lectures (42 decks)

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