MS

Question 1

what is multiple sclerosis

Answer 1

chronic and progressive condition that involves demyelination of the myelinated neurones in the central nervous system
- caused by an inflammatory process involving the activation of immune cells against the myelin

Question 2

pathophysiology of MS

Answer 2

T-cell mediated autoimmune disease that causes an inflammatory process mainly within the white matter of the brain and spinal cord

plaques of demyelination occur anywhere in CNS white matter but have a predilection for certain sites including the optic nerves, the brainstem and its cerebellar connections and the cervical cord (corticospinal tracts and posterior columns)

Question 3

pathophysiology of lower urinary tract dysfunction in MS

Answer 3

increased tone at bladder neck
detrusor hypersensitivity
detrusor sphincter dyssynergia

Question 4

patterns of MS

Answer 4

relapsing-remitting MS
secondary progressive MS
primary progressive MS

Question 5

clinical presentation of MS- pyramidal dysfunction

Answer 5

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

Question 6

clinical presentation of MS- Optic neuritis

Answer 6

painful visual loss over 1-2 weeks- blurred vision in one eye and loss (or reduction) in colour vision
most improve
RAPD (relative afferent pupilary defect) on examination

Question 7

clinical presentation of MS- sensory symptoms

Answer 7

pain
paraesthesia
dorsal column loss- proprioception and vibration
numbness
trigeminal neuralgia

Question 8

clinical presentation of MS- lower urinary tract dysfunction

Answer 8

increased frequency and urgency
nocturia
urge incontinence
retention

Question 9

cerebellar dysfunction

Answer 9

dysarthria
ataxia
intention tremor
past pointing
pendular reflexes
dysdiadokinesis

Question 10

clinical presentation of MS- brainstem dysfunction

Answer 10

diplopia- CN VI palsy
facial weakness- CN VII palsy

Question 11

clinical presentation of MS- internuclear ophthalmoplegia

Answer 11

involves the medial longitudinal fasciculus
distortion of binocular vision
failure of adduction- diplopia
nystagmus in abducting eye
lag

Question 12

clinical presentation of MS- fatigue

Answer 12

physical and cognitive
sense of exhausation

Question 13

investigations for MS

Answer 13

bloods: FBC, inflammator markers, U&E, LFT, TFT, glucose, HIV serology, calcium and B12

Question 14

diagnosis of MS

Answer 14

MRI scans can demonstrate typical lesions

Lumbar puncture can detect “oligoclonal bands” in the cerebrospinal fluid (CSF)

Question 15

management of MS- acute relapse

Answer 15

Mild- symptomatic treatment

Moderate- oral steroids (methylprednisolone- 500mg oral for 5 days)

Severe- admit/IV steroids- 1000mg if admitted

Question 16

DMARD management of MS