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Year 4: Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

what is MS

A

inflammatory demyelinating disorder of the CNS

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2
Q

what is meant by plauqes

A

areas of inflammation caused by T-cell mediated response

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3
Q

what are the 4 patterns of MS

A

Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive

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4
Q

how does demyelination cause symptoms

A

acute relapses are caused by focal inflammatory demyelination – causes conduction block
severe damage causes permanent axonal destruction

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5
Q

how does MS normally present

A 
monosymptomatic 
unilateral optic neuritis 
numbness/tingling in limbs
leg weakness
ataxia
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6
Q

what are signs of pyramidal dysfunction

A

increased tone
spasticity
weakness
affects extensors of upper limbs and flexors of lower limbs

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7
Q

what is Sx of optic neuritis

A

painful visual loss
lasts 1-2weeks
most improve (but not always)
associated with RAPD

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8
Q

what is RAPD

A

condition in which pupils respond differently to light stimuli shone in one eye at a time

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9
Q

what are sensory Sx of MS

A 
pain
paraesthesia
numbness 
trigeminal neuralgia 
dorsal column loss
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10
Q

what is lost in dorsal column damage

A

proprioception and vibration loss

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11
Q

what are cerebellar dysfunction Sx

A

DANISH

  • Dysdiadokinesis
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonia
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12
Q

what are Sx of brain stem dysfunction

A

Diplopia = VI palsy

Facial weakness = VII palsy

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13
Q

what ophthalmic condition is almost seen exclusively in MS

A

Internuclear ophthalmoplegia

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14
Q

what is Internuclear ophthalmoplegia

A

caused by injury/dysfunction in the Medial longitudinal fasciculus

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15
Q

what are Sx of Internuclear ophthalmoplegia

A

Distortion of binocular vision
Failure of adduction- diplopia
Nystagmus in abducting eye
Lag

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16
Q

what are Sx of lower urinary tract dysfunction in MS

A 
frequency
nocturia
urgency
urge incontinence
retention
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17
Q

what could Sx of lower urinary tract dysfunction in MS be confused with

A

BPH

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18
Q

what is used to treat fatigue in MS

A

amantadine

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19
Q

what is needed for a diagnosis of MS

A

At least 2 episodes suggestive of demyelination

Dissemination in time and place

20
Q

what would Ddx be in MS

A

Vasculitis
Granulomatous disorder e.g. sarcoidosis
Vascular disease e.g. stroke
Structural lesion e.g. mass pressing on spinal cord
Infection
Metabolic disorder e.g. folate deficiency

21
Q

what is the most sensitive test for MS

A

MRI

22
Q

why are blood tests done in suspected MS

A

don’t rule in MS but they rule out other differentials

23
Q

what blood tests should be done, and come back negative, to ensure it is MS

A

Plasma viscosity, FBC, CRP
Renal liver bone profile
Auto anti body screen - should be normal in MS
Borellia (lime disease), HIV, syphilis serology
B12 and folate

24
Q

what in the CSF suggests inflammation

A

oligoclonal bands of IgG on electrophoresis

25
Q

what are the 3 categories of management of MS

A

acute exacerbation
symptomatic treatment
disease modifying treatment

26
Q

what is the treatment of acute exacerbation of MS

  • Mild
  • Moderate
  • Severe
A

mild - symptomatic Tx
moderate - oral steroids
severe - admit/IV steroids

27
Q

what are tx options for pyramidal dysfunction

A

physio
occupational therapy
anti spasmodic agents
muscle relaxants - e.g. oral baclofen

28
Q

what are anti spasmodic agents

A

baclofen
tizanidine
Botox

29
Q

what can be given in severe cases of bed bound patients

A

Intrathecal baclofen / phenol

30
Q

what Tx can be given for sensory symptoms

A

anti convulsant eg. gabapentin

anti depressant eg.amitriptyline

31
Q

what causes lower urinary tract dysfunction in MS

A

increased tone at bladder neck

detruser hypersensitivity

32
Q

Tx for lower urinary tract dysfunction

A

anti-cholinergics eg. oxybutynin

desmopressin - stops urine production so only given for short period of time, i.e. they have to go on a plane journey

catheterisation

33
Q

what is the first line therapy for disease modifying treatment

A

Interferon Beta – Avonex, Rebif, Betaseron, Extavia

Tecfedira

34
Q

what is second line therapy for disease modifying

A

Monoclonal antibody – Tysabri, Lemtrada

Fingolimod

35
Q

what is third line therapy for disease modifying

A

Mitoxantrone

36
Q

what treatment is first line in relapsing remitting MS

A

Tecfidera

37
Q

when is monoclonal antibody drugs indicated in MS

A

highly active relapsing remitting multiple sclerosis

38
Q

what is a deadly SE that needs to be looked for in Tysabri

A

Progressive multifocal leukoencephalopathy

39
Q

what are SE of the interferons

A

flu Sx
depression
abortion

40
Q

what is the most common pattern of MS

A

Relapsing-Remitting

41
Q

what are features of RR MS

A

episodes of exacerbations/relapses i.e. clearly defined attacks of new or increasing neurologic symptoms

followed by periods of partial or complete recovery (remissions)

no progression of the disease during remission

42
Q

what are features of Primary Progressive MS

A

worsening neurologic function from the onset of symptoms, without early relapses or remissions.

43
Q

what are secondary progressive MS

A

initial relapsing-remitting course

transition to a secondary progressive course in which there is a progressive worsening of neurologic function

44
Q

what is progressive relapsing MS

A

pattern of relapses within primary progressive MS

least common

45
Q

risk factors for MS

A

smoking
previous infectious mononucleosis
genetics - HLA DRB1*15 carrier
vit D deficiency

Year 4: Neurology (24 decks)

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