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Applied Pathophysiology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What are the 3 theories for MS cause?

A

infectious theory
molecular mimicry
autoimmune disease

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2
Q

what is the prevalence of MS in Canada?

A

1:500-1:1000 (rare disease)

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3
Q

What is the first step to the autoimmune response for MS?

A

APC picks up foreign protein and binds to naive T cell receptor (CD28)

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4
Q

What types of cells are APCs?

A

macrophages
monocytes
dendritic cells

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5
Q

What is the second step to the autoimmune response for MS?

A

T cell becomes pro-inflammatory TH1 cell

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6
Q

What is the third step to the autoimmune response for MS?

A

TH1 activates pro-inflammatory cytokines, leading to an imbalance between pro- and anti-inflammatory cytokines

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7
Q

what is the fourth step to the autoimmune response for MS?

A

blood becomes jam packed with TH1 cells and adhere to the blood brain barrier (BBB) through adhesion molecules and dock to BBB

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8
Q

What is the fifth step to the autoimmune response for MS?

A

TH1 cells are still producing inflammatory mediators and activates proteases, which loosen the integrity of BBB. mediators can now get to CNS

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9
Q

what is the sixth step to the autoimmune response for MS?

A

TH1 cells in CNS find the protein (in this case, myelin) that looks like the protein presented by the APC, and the cycle continues in the CNS, damaging the myelin

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10
Q

what is white matter disease?

A

when immune cells damage myelin

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11
Q

What are some contributing factors associated with MS?

A 
race (caucasian)
age (25 and 38?)
sex
infection
injury
genetics
diet/sunshine
geography (hot spots)
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12
Q

what is the typical age range of onset for MS?

A

30-40yrs

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13
Q

what gender is more affected by MS?

A

3 women: 1 men

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14
Q

How do genetics play a role in MS?

A

slightly higher predisposition, but is not hereditary

HLA-DR2 allele

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15
Q

What is typically examined to determine MS?

A

CSF

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16
Q

what do you look for in CSF to diagnose MS?

A

oligoclonal IgG bands

17
Q

why are oligoclonal IgG bands significant in MS?

A

shows antibodies against oligodendrocytes (produce myelin) in over 95% of MS patients

18
Q

How is an MRI helpful in MS diagnosis?

A

look for white spots (peri-ventricular lesions) to indicate the immune system attacking myelin
also look for neurological atrophy

19
Q

What are the requirements for a definitive MS diagnosis according to the McDonald clinical criteria?

A

1) clinical attacks +/- MRI must show spreading in time and space
2) 2 clinical attacks where each attack lasted more than 24hrs, and are at least 30 days apart

Does not require an MRI

20
Q

What is the clinical course of MS?

A

Pt shows first clinical attack (above clinical threshold) and seek med attention
Symptoms go away for a while
Demyelination during early course of disease usually stays under clinical threshold
As disease progresses, attacks and relapses stay above clinical threshold, leading to permanent damage

21
Q

What are some MS induced symptoms? which is the most common? state why each occurs. (6pts)

A

1) Fatigue/weakness (most common) - electrical energy needed to move is leaking out of damage myelinated fibers
2) Bladder control problems - bladder retention (not getting excitatory signal) or bladder leaker (not getting inhibitory signal)
3) Neuropathic pain - antibodies eating at myelin
4) Cognitive defects - nerve cells responsible for short/long term memory die (could lead to optic neuritis or sexual dysfunction depending on affected nerve fibres)
5) Ataxia (like you’re drunk) - nerve fibres eroding
6) Depression - unable to do what you could before

22
Q

How much of a disability decrease is there if treatment is started at diagnosis compared to no treatment at all?

A

50%

23
Q

How much of a disability decrease is there if treatment is started part way through disease course compared to no treatment at all?

A

~33%

24
Q

what are the 4 kinds of MS? Which is most common?

A

Relapsing-remitting MS - most common
secondary progressive MS
primary progressive MS
progressive relapsing MS

25
Q

what is RRMS?

A

patient has an attack then recovers

26
Q

what is SPMS?

A

starts as RRMS, attack then relapse but not back to normal (above clinical threshold)

27
Q

What is PPMS?

A

have one attack and don’t recover, only gets worse (sometimes triggered by trauma)

28
Q

What is PRMS?

A

disease gets steadily worse from beginning but with relapses

29
Q

what is clinically isolated syndrome?

A

1 attack lasting more than 24hrs even with an MRI that doesn’t fulfill McDonald criteria regarding spreading in time and/or space
Can’t diagnose as MS

30
Q

If you were diagnosed with MS, how long before you need a cane/crutch? wheelchair?

A

cane - 15yrs

wheelchair - 25yrs

Applied Pathophysiology (11 decks)

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