Multiple Sclerosis

Question 1

4 different courses of MS

Answer 1

relapsing remitting
primary progressive
secondary progressive
progressive relapsing

Question 2

describe the progression of relapsing remitting

Answer 2

bad flare, recover to same or worse, on loop

Question 3

describe the progression of primary progressive

Answer 3

just steadily getting worse and worse

Question 4

describe the progression of secondary progressive

Answer 4

initially relapsing remitting but then just gets steadily worse

Question 5

relapsing progresssive

Answer 5

steadily getting worse with relapses that don’t fully recover

Question 6

presentation of MS

Answer 6

very varied
Optic neuritis
motor impairment
paraesthesia
numbness
bladder dysfunction
sexual dysfunction
cognitive decline
vertigo
ataxia
maaaany many things

Question 7

how is MS diagnosed

Answer 7

history: 2 or more episodes of 2 or more symptoms in different areas
tests: MRI to see lesions

Question 8

what tests might your order in MS

Answer 8

MRI - for lesions
LP - for oligoclonal bands (inflammatory markers) in CSF
Bloods - exclude other inflammatory/infection

Question 9

what is the most common type of MS

Answer 9

relapsing remitting 85%

Question 10

10-15% of MS is what type

Answer 10

primary progressive

Question 11

proportion that will need a wheelchair at some point

Answer 11

25%

Question 12

proportion that MS never affect activities of daily living

Answer 12

25%

Question 13

who is the prognosis worst for

Answer 13

males, older, those with motor symptoms

Question 14

true/false a presentation of optic neuritis is associated with a good prognosis

Answer 14

true - as are long relapse intervals and not having many relapses in the first 5 years

Question 15

when does primary progressive usually present

Answer 15

late - 5th and 6th decade

Question 16

bladder and spinal symptoms are common in which type

Answer 16

primary progressive

Question 17

treatment of acute relapse

Answer 17

IV steroids to reduce inflammation (prednisolone)

Question 18

true/false MS is worse during pregnancy

Answer 18

false - symptoms ease off

Question 19

MDT that would be involved in MS

Answer 19

OT and physio, MS nurse, SLT, dietician, rehabilitation specialist, psychiatry

Question 20

general management of MS

Answer 20

MDT, eduacation, tell DVLA, vaccinations

Question 21

true/false - MS doesn’t always require long term maintanence treatment

Answer 21

true - however there are some disease modifying treatments

Question 22

when is the risk of relapse highest in pregnancy

Answer 22

3 months post partum

Question 23

disease modifying drugs in MS

Answer 23

beta-inteferons, glatiramer acetate

Question 24

how do beta-interferons work

Answer 24

by reducing inflammation

Question 25

general criteria for disease modifying drugs

Answer 25

able to walk
had >2 relapses in last 2 years
relapsing remitting disease

Question 26

how does glatiramer acetate work

Answer 26

immunosuppression

Question 27

how often are disease modifying drugs given

Answer 27

daily –> weekly. intramuscular or subcut

Question 28

effectiveness of first line drugs

Answer 28

reduce relapse rate by 33%

Question 29

symptomatic treatments of MS

Answer 29

muscle relaxants
analgesia
anticholinergics for bladder
catheterisation
laxatives
exercise
CBT for depresion
anti-tremor stuff
memory aids for cognitive decline