MS

Question 1

MS is particular to the CNS or the PNS?

Answer 1

CNS so oligodendrocyte

Question 2

Comment on the prevalence of MS in relation to the equator

Answer 2

Further north or further south of equator you go, prevalence is higher

Question 3

First degree relative with MS, what is risk?

Answer 3

3-5%

Question 4

Identical twin with MS, chance of developing?

Answer 4

1/3

Question 5

Factors contributing to MS? (3)

Answer 5

Genetics, environment immune response

Question 6

85-90% patients will have what type of MS?

Answer 6

Relapsing remitting MS (RRMS)

Question 7

20-50% of RRMS develop what?

Answer 7

Secondary progressive MS (SPMS)

Question 8

10-15% of patients with MS is what type?

Answer 8

Primary Progressive MS (PPMS)

Question 9

What is multiple sclerosis and what is the name of its lesions?

Answer 9

Inflammatory demyelinating disorder of the CNS, plaques

Question 10

Female:Male ratio of MS

Answer 10

3:1 F:M

Question 11

In what age group do most MS patients initially present?

Answer 11

30s and 40s

Question 12

List 6 possible clinical features of MS

Answer 12

Pyramidal dysfunction, 
Optic neuritis, 
Sensory symptoms
Lower urinary tract dysfunction,
Cerebellar and brain stem features,
Cognitive impairment

Question 13

List 3 symptoms of pyramidal dysfunction

Answer 13

Increased tone, (velocity dependent)
Spasticity,
Weakness in pyramidal distrubiton

Question 14

What is weakness in pyramidal distribution?

Answer 14

Weakness in extensors of upper limbs and flexors of lower limbs

Question 15

Approx 40% of patients with MS present with optic neuritis. Basic presentation of optic neuritis?

Answer 15

Painful visual loss over 1-2 weeks. May present with RAPD

Question 16

List 5 sensory symptoms of MS

Answer 16

Pain, 
Paraesthesia, 
Dorsal column loss, 
Numbness, 
Trigeminal neuralgia (very common in MS)

Question 17

List 7 symptoms of cerebellar dysfunction

Answer 17

Dysarthria,
Ataxia,
Nystagmus,
Intention tremor, 
Past pointing, 
Pendular reflexes, 
Dysdiadokinesis

Question 18

MS patients with ataxia from cerebellar dysfunction tend to veer towards the contralateral side of lesion. True/false?

Answer 18

False - veer towards same side as lesion

Question 19

Brain stem dysfunction depends on where lesion is. A lesion of R brainstem could cause both R VI palsy and R VII palsy, how would this present?

Answer 19

Diplopia

Facial weakness

Question 20

A plaque on the medial longitudinal fasciculus would cause what? What are the symptoms (4)?

Answer 20

Internuclear opthalmoplegia.

Symptoms: distortion of binocular vision, failre of adduction (diplopia), nystagmus in abducting eye, lag

Question 21

What is an additional very common MS symptom?

Answer 21

Fatigue

Question 22

Lower urinary tract dysfunction in MS can present as frequency, nocturia, urgency, urge incontinence and retention. What 2 problems cause this?

Answer 22

Increased tone of bladder neck and irritability of detrusor muscle

Question 23

MS investigations (4)

Answer 23

Blood tests, MRI, CSF, neurophysiology (e.g. EEG)

Question 24

List 6 DD for MS symptoms

Answer 24

Vasculitis, 
Granulomatous disorder, 
Vascular disease,
Structural lesion, 
Infection, 
Metabolic disorder e.g. B12 and folate deficiency

Question 25

List specific blood tests for MS to rule out other diseases

Answer 25

``` PV, FBC, CRP, Renal liver bone profile, Auto antibody screen, Borellia, HIV, syphilis serology, B12 and folate, Vit D ```

Question 26

Borellia is the bacteria that causes what disease that can mimic MS?

Answer 26

Lyme disease

Question 27

PV, FBC and CRP bloods are done to check for inflammation caused by other inflammatory diseases and not MS. True/false?

Answer 27

True

Question 28

List 2 sequences of MRI for identifying MS

Answer 28

T2 + FLAIR

Question 29

What is needed for MS diagnosis?

Answer 29

Clinical episode, dissemination in time and place, exclusion of other causes

Question 30

Oligoclonal bands tend to be present in most MS patients CSF. What is abnormal result?

Answer 30

Unmatched oligoclonal bands in CSF. Unmatched means there aren’t the same ones in the serum

Question 31

Acute relapse treatment for mild, moderate and severe

Answer 31

Mild: symptomatic treatment, Moderate: high dose oral steroids, Severe: admit/IV steroids

Question 32

List 4 treatments for spasticity

Answer 32

Physio, Antispasmodics Botulinum toxin, Intrathecal baclofen

Question 33

Give 2 examples of antispasmodics used in MS

Answer 33

Baclofen, | Tizanidine

Question 34

List 5 treatments for sensory symptoms of MS

Answer 34

``` Anticonvulsant e.g. gabapentin, Antidepressant e.g. amitriptyline, Tens machine, Acupuncture, Lignocaine infusion ```

Question 35

List 4 treatments for lower urinary tract dysfunction in MS

Answer 35

Bladder drill, Anticholinergics e.g. oxybutynin, Desmopressin, Catheterisation

Question 36

Occupation health nurses, amantadine & modafinil (less), hyperbaric oxygen are all treatment for what symptoms of MS?

Answer 36

Fatigue

Question 37

What is cannibas licensed for?

Answer 37

Resistant spasticity

Question 38

Efficacy of MS treatment depends on when treatment is given - true/false?

Answer 38

True

Question 39

What is first line disease modifying therapy for MS? Which is injectable?

Answer 39

Tecfedira/aubagio (tablets), interferon beta (injectable), glitiramer acetate (injectable)

Question 40

What is second line disease modifying therapy for MS?

Answer 40

Monoclonal antibody e.g. tysabri, ocrevus, lemtrada, | Fingolimod

Question 41

What is third line disease modifying therapy for MS?

Answer 41

Mitoxantrone (less as toxic to heart), HSCT (stem cell transplantation)

Question 42

1st line DMARD used when?

Answer 42

Relapse onset MS

Question 43

When is second line disease modifying therapy licensed for use in MS? (2)

Answer 43

If tried first line or have very aggressive MS

Question 44

FBC and liver function monitoring must be done every _ months for patients on tecfedira?

Answer 44

3 months

Question 45

Interferons and glitiramer acetate decrease relapse rate by how much? They decrease severity of relapses by how much?

Answer 45

Decrease relapse rate by 1/3 and decrease severity of relapses by 50%

Question 46

What is first line tablet for RRMS? What is approximate relapse rate?

Answer 46

Tecfidera - 44% reduction in relapse rate

Question 47

Second line tablets for MS are? What is reduction in relapse rate?

Answer 47

Fingolimod/cadrabine, >50% reduction in relapse rate

Question 48

Monoclonal antibody ocrelizumab targets what site?

Answer 48

Anti CD 20

Question 49

Monoclonal antibody alemtuzemab targets what site?

Answer 49

Anti CD50

Question 50

Monoclonal antibody natilizumab targets what site?

Answer 50

Anti integrin

Question 51

Monoclonal antibodies are licensed when?

Answer 51

In highly active RRMS e.g. patient with rapidly evolving severe RRMS or patients who already tried interferon/glitiramer acetate

Question 52

Which is best treatment but worst side effect?

Answer 52

Monoclonal antibodies