Exam 4 MS Flashcards Preview

Q4 Clin Med III (GI) > Exam 4 MS > Flashcards

Flashcards in Exam 4 MS Deck (19):
1

Multiple Sclerosis is?

Autoimmune dz w/ genetic component ->
Slow demyelination of CNS affecting brain, spinal cord, optic nerve

Most C neuro disability in early/mid adulthood (except trauma)

2

MS pathophys?

Most affected areas?

Attack of nerve fiber myelin sheath ->
Causes plaques of demyelination

-White matter of cervical and dorsal regions of lateral and posterior columns of brain stem
-Optic nerve and periventricular area in brain

3

MS "Key Feature"?

CNS white matter lesions separated by time and space

4

MS presentation?

U white female, Ave onset 30 yo
Insidious, waxing/waning
Visual ∆s
Dizziness
Paresthesia extrem, trunk, unilat face
↓ coordination
Dysdiadochokinesia (↓ rapid alternating mvmt)
Pain
↓ Bowel/bladder control
↓ Cognition

5

MS exam findings: Internuclear ophthalmoplegia?

Medial rectus weakness when CN III and IV involved in mvmt:
Eye can't turn in to look at nose on one side (conjugate gaze)
e.g. right eye looks right, left eye stay looking straight

However, both eyes will converge (both look medially) because signal only involves CN III

6

MS exam findings: Lhermitte's Symptom?

Neck flexion causes electrical shock down back and legs

7

MS exam findings: Optic neuritis? (3)

↓ acuity
Papilledema
Marcus Gunn Pupil

8

Marcus Gunn Pupil

Affected pupil consensually responds to good eye:
Pupil contracts to indirect light normally, but dilates to direct light
(follows lead of opposite eye that is now dilated in absence of direct light)

9

MS exam findings: Pyramidal tract involvement? (5)

(UMN sxs)
Hyper-reflex
Clonus
No abdominal reflexes
+ Babinski (Big toe extends, others fan out)
Limb weakness

10

MS exam findings: Cerebellar involvement? (4)

Nystagmus
Incoord
Dysarthria (unclear speech)
Ataxia

11

MS exam findings: Posterior column invovement? (3)

↓ vibration
↓ proprioception
Lhermitte's

12

Relapsing/Remitting MS presentation?

Sxs develop over 1-2 wks,
Resolve in 4-8 wks
Most begin w/ this pattern

13

Secondary progressive MS presentation?

Starts as Relapse/Remit
~ 5 yrs becomes Relapse/Progressive

14

Primary progressive MS presentation?

Gradual progression from onset
Most C w/ onset > 40 yo

15

MS CSF findings? (3)

P > 5 mononuclear cells
↑ IgG
Oligoclonal bands

16

MS imaging?

MRI best test: Bright signal plaques

Evoked Potential test: measures time for stim to eye, ear or periphery to reach cerebral cortex

17

MS DDX? (5)

↓ B12, Vit E
Thyroid/Adrenal dzs
Collagen vascular dz (RA, SLE, etc)
Syphilis, HIV
Inherited ataxias

18

MS tx?

No cure

Acute attack: high-dose steroids

Chronic:
Alpha4 agonist (natalizumab) reduces brain lesions
Interferon β1 + glatiramer (myelin protein)
P immunosupp

19

MS sxs tx:

Spasticity?

Ataxia?

Incontinence?

Sex dysfxn?

Pain?

Fatigue?

Spasticity = mm relax/anti-spast

Ataxia = none effective

Incontinence = anticholinergic

Sex dysfxn = Viagra

Pain = Baclofen, clonazepam, gabapentin

Fatigue = amantadine, ritalin