Multiple Sclerosis Flashcards

1
Q

what is MS

A

autoimmune degenerative condition causing inflammatory lesions throughout the CNS

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2
Q

outline the pathophysiology of MS

A

areas of nerves lack myelin sheath as oligodendrocytes are destroyed, inflammation develops causing ‘plaques’

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3
Q

what is pathonomonic of MS

A

inflammatory plaques must be disseminated in space and time

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4
Q

what are some of the risk factors for MS

A

genetic predisposition
having EBV in childhood
associated with increased latitude

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5
Q

what are the 4 types of MS

A

relapsing remitting
secondary progressive
primary progressive
progressive relapsing

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6
Q

describe relapsing remitting MS

A

most common type

goes through phases of symptoms then they regress to complete recovery

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7
Q

describe secondary progressive MS

A

symptom progression is slow however patient is always symptomatic
relapsing remitting goes onto develop into this

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8
Q

describe primary progressive MS

A

10% of cases but most severe form

steady decline with no improvement of symptoms

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9
Q

describe progressive relapsing MS

A

steady decline from onset of symptoms with super imposed relapses
rarest type

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10
Q

outline the broad clinical features of MS

A
varies depending on where lesions are present 
motor 
sensory 
transverse myelitis 
cerebellar 
ocular features
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11
Q

outline the motor features of MS

A
pyramidal features 
increased tone 
weakness 
spasticity 
visible extensor muscles
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12
Q

outline the sensory features of MS

A

numbness
tingling pain
trigeminal neuralgia

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13
Q

outline the features of transverse myelitis

A

loss of motor, sensory and autonomic function

loss of bowel and bladder control - urge incontinence

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14
Q

outline the cerebellar features of MS

A
DANISH 
dysdiadochokinesia 
ataxia 
nystagmus 
intention tremor 
staccato speech 
hypotonia
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15
Q

outline the optic features of MS

A

optic neuritis
sudden loss of vision
double vision
anterior uveitis

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16
Q

which is a common first presentation

A

optic neuritis

17
Q

what is Lhermittes phenomenon

A

electric shock in arms when head is bent forward

18
Q

what is Uhtoffs phenomenon

A

worsening of symptoms with heat and exercise

19
Q

outline some of the possible examination findings of MS

A

spasticity, brisk reflexes, +ve Babinski sign

nystagmus, RAPD, internuclear ophthalmoplegia

20
Q

outline the diagnostic criteria for MS

A

two episodes of symptoms of MS that last at least an hour and are at least 30 days apart - shows dissemination in space and time

21
Q

list the investigations and their findings for MS

A

MRI - shows optic neuritis and plaques of demyelination

lumbar puncture - oligoclonal bands of IgG found on electrophoresis

22
Q

how is spasticity managed in MS

A

baclofen
physiotherapy
occupational therapy

23
Q

how are sensory problems managed in MS

A

amitriptyline
gabapentin
TENS acupuncture

24
Q

how is bladder dysfunction managed

A

bladder training

oxybutynin

25
Q

how is an acute exacerbation of MS managed

A

anti-convulsants such as gabapentin/pregabalin

oral or IV methylprednisolone depending on severity

26
Q

what are the first line DMARDs for MS

A

B interferon
capaxone
tecfidera