NM Multiple Sclerosis

Question 1

Chronic, degenerative, _________ disease of CNS

Answer 1

Demyelinating

Question 2

Etiology is unknown but likely _____, _________

Answer 2

Viral, autoimmune

Question 3

Demyelinating lesions (________) impair neural transmissions, so nerves ______ ______

Answer 3

Plaque

Fatigue fast

Question 4

Where are the lesions common?

Answer 4

Pyramidal tract
Dorsal columns
Periventricular areas of cerebrum
Cerebellar peduncles

Question 5

Precipitating/exacerbating factors include what 4 things?

Answer 5

Infection
Trauma
Pregnancy
Stress

Question 6

Transient worsening symptoms =
Adverse reaction to \_\_\_\_\_
\_\_\_\_\_\_\_
\_\_\_\_\_
\_\_\_\_\_\_

Answer 6

Heat
Dehydration
Hyperventilation
Fatigue

Question 7

What is the most common type?

Answer 7

RRMS

Question 8

What is relapsing remitting MS? (RRMS)

Answer 8

Discrete attacks of relapses with either full or partial remissions in subsequent weeks/months

Question 9

What is primary progressive MS? (PPMS)

Answer 9

Disease progression and deterioration in function from onset
Modest fluctuation in Neuro disability
NO DISCRETE ATTACKS

Question 10

What is secondary progressive MS (SPMS)?

Answer 10

Starts off as RRMS but then changes to PPMS, with or without continued acute attacks

Question 11

What is progressive relapsing MS (PRMS)?

Answer 11

Steady deterioration with acute attacks occasionally

Question 12

What is clinically isolated syndrome?

Answer 12

1st episode of inflammatory demyelination in the CNS that could become MS if more activity occurs
Can progress to RRMS

Question 13

What Dx tests would you do?

Answer 13

LP/CSF — would show increased gamma globulin
CT/MRI
Myelogram
EEG

Question 14

Exam includes:

1) History
2) Cog/affective status — what are you looking for?

Answer 14

Mild-mod cog impairment common; euphoria, emotional dysregulation

Question 15

Exam includes:

3) Communication — what are you looking for?

Answer 15

Dysarthria
Scanning speech
Dysphasia

Question 16

Exam includes:

4) ROM/deformity: associated with ____

Answer 16

Disuse

Question 17

Exam includes:

5) sensation: what are you looking for?

Answer 17

Parasthesias
Hyperpathia
Dysesthesia
Trigeminal neuralgia
Lhermitte’s sign

Question 18

Exam includes:

6) Vision: what may you see?

Answer 18

Diplopia
Blurred vision
Optic neuritis
Scotoma (blind spot)
Nystagmus

Question 19

Exam includes:

7) skin integrity
8) Muscle tone, DTRs: what would you see?

Answer 19

Spasticity

Hyperreflexia

Question 20

Exam includes:

9) muscle strength/control: ______

Answer 20

Paresis

Question 21

Exam includes:

10) coordination: you may see what?
11) balance: ______ involvement

Answer 21

Ataxia
Intention tremor
Dysmetria
Dysdiadochokinesia

Vestibular

Question 22

Exam includes:

12) gait may be _________

Answer 22

Ataxia

Question 23

Exam includes:

_______ is the number one complaint as the day progresses

Answer 23

Fatigue

Question 24

What classes of drugs are used?

Answer 24

Immunosuppressant drugs
Interferon drugs
Sx management of spasticity
Sx management of urinary problems

Question 25

What are the immunosuppressant drugs that are used?

Answer 25

ACTH | Steroids (-sone)

Question 26

What are the interferon drugs that are used?

Answer 26

Avonex Betaseron Copaxone

Question 27

What spasticity drugs are used?

Answer 27

Baclofen, diazepam (Valium), dantrolene Baclofen pump Phenol block surgery

Question 28

What urinary drugs are used?

Answer 28

Anticholinergics

Question 29

What two things should you watch out for in your pts with MS?

Answer 29

UTI and respiratory infection

Question 30

What intervention can you use with diplopia?

Answer 30

Eye patching

Question 31

_______ ______ techniques are important for this population

Answer 31

Energy conservation

Question 32

Avoid precipitation exacerbations: Use _________ practice schedule Rest intervals should be carefully ___________ ____ time > _____ time Exercise should increase in _____ before _______

Answer 32

DISTRIBUTED Spaced Rest time > exercise time Duration before intensity