Multiple Sclerosis

Question 1

What is MS.

Answer 1

Chronic disease of the CNS.

Question 2

What is MS characterised by. (2)

Answer 2

White plaques (areas of demyelination and perivascular inflammation) disseminated in time and occurring anywhere in the CNS (at multiple sites). 
Causes relapsing and remitting symptoms. 
Prolonged demyelination causes axonal loss and clinically progressive symptoms.

Question 3

When does MS tend to affect people.

Answer 3

During their reproductive years.

Question 4

What is the cause of MS. (2)

Answer 4

T cell mediated immune response (trigger unknown).

Question 5

What interesting pattern is present with the incidence of MS.

Answer 5

Incidence increases with distance from the equator.

Question 6

What are the symptoms of MS dependent on.

Answer 6

The position of the plaques.

Question 7

What are the usually patterns of symptoms of MS. (3)

Answer 7

Usually follows a relapsing-remitting course.

But can be primary progressive, secondary progressive or progressive relapsing.

Question 8

What are the most common presentations of MS. (6)

Answer 8

Internuclear ophthalmoplegia. 
Unilateral optic neuritis. 
Numbness or tingling in the limbs. 
Cerebellar/brainstem syndrome (diplopia, ataxia). 
Leg weakness. 
Lhermitte's sign.

Question 9

What is Lhermitte’s sign.

Answer 9

Electric sensation down spine on neck flexion.

Question 10

What is internuclear ophthalmoplegia. (3)

Answer 10

Eg. Left internuclear ophthalmoplegia:
The lesions affects the left medial longitudinal fasciculus (MLF).
This prevents adduction of the ipsilateral eye during conjugate gaze.
Convergence is usually normal.

Question 11

What is usually seen on a CSF/lumbar puncture of a patient with MS. (3)

Answer 11

Raised protein.
Raised immunoglobulin levels.
Oligoclonal bands.

Question 12

What is usually seen on a MRI of a patient with MS.

Answer 12

Demyelinating lesions.

Question 13

What is the average survival time after diagnosis with MS.

Answer 13

25-35 years.

Question 14

What is important to consider after diagnosis of MS.

Answer 14

There is an increased risk of suicide.

Question 15

What is the lifetime risk of developing MS in the UK.

Answer 15

1:1,000.

Question 16

What is the mean age of onset of MS.

Answer 16

30.

Question 17

What is the female:male ratio of MS.

Answer 17

3:1.

Question 18

What is the relationship of vitamin D status to MS. (2)

Answer 18

Relates to prevention of MS.

Fewer symptoms and fewer new lesions on MRI in established MS.

Question 19

What ethnic groups are at decreased risk of MS. (2)

Answer 19

Black Africans.

Asians.

Question 20

How does MS usually present initially.

Answer 20

Monosymptomatic.

Question 21

What is a rare presentation of MS.

Answer 21

Polysymptomatic.

Question 22

What may worsen the symptoms of MS. (2)

Answer 22

Heat (eg hot bath).

Exercise.

Question 23

What is the natural history of MS. (4)

Answer 23

Early on, relapses (which can be stress induced) may be followed by remission and full recovery.
With time, remissions are incomplete, so disability accumulates.
Steady progression of disability from the outset occurs.
Some patients experience no progressive disablement at all.

Question 24

What are poor prognostic signs of MS. (5)

Answer 24

Older male . 
Motor signs at onset. 
Many relapses early on. 
Many MRI lesions. 
Axonal loss.

Question 25

What is the diagnosis criteria for MS.

Answer 25

Clinical assessment.

Requires lesions disseminated in time and space, unattributed to other causes.

Question 26

What are some sensory symptoms of MS. (4)

Answer 26

Dysaesthesia.
Pins and needles.
Reduced vibration sensation.
Trigeminal neuralgia.

Question 27

What are some motor symptoms of MS. (2)

Answer 27

Spastic weakness.

Myelitis.

Question 28

What arre some sexual/GU symptoms of MS. (4)

Answer 28

Erectile dysfunction.
Anorgasmia.
Urine retention.
Incontinence.

Question 29

What are some GI symptoms of MS. (2)

Answer 29

Swallowing disorders.

Constipation.

Question 30

What are some eye disorders of MS. (6)

Answer 30

Diplopia. 
Haemianopia. 
Optic neuritis. 
Visual phenomena. 
Bilateral internuclear ophthalmoplegia. 
Pupil defects.

Question 31

What are some cerebellar signs of MS. (4)

Answer 31

Trunk and limb ataxia.
Intention tremor.
Scanning speech.
Falls.

Question 32

What are some cognitive/visuospatial decline features of MS. (4)

Answer 32

Decrease in executive functions.
Amnesia.
Variable mood.
Big cause of unemployment, accidents and isolation in patients with MS.