MS

Question 1

?

Answer 1

Autoimmune disease of the myelin (particularly oligodendrocytes)

Question 2

Function of myelin?

Answer 2

Protective layers of the nerve fibers

Question 3

Which part of the body does it affect

Answer 3

Brain
Spinal cord
Optic nerves

Question 4

Which stage of life does it present

Answer 4

Early adults hood

Question 5

The types of MS?

Answer 5

Relapsing-remitting - RRMS

Secondary progressive - SPMS

Primary progressive - PPMS

Question 6

In which type is there no remission no relapse and the symptoms are gradual from symptom onset

Answer 6

PPMS

Question 7

In which type is there relapse followed by remission - comes and goes

Answer 7

RRMS

Question 8

In which type does it start off like RRMS, and then steadily gets worse over time

Answer 8

SPMS

Question 9

Clinical presentations

Answer 9

• vision disturbances
• seonsroy problems (electric ship sensation along the spine and numbness)
• bowel/bladder problems
• cognitive problems

Question 10

Go will rule our other conditions MS is suspected

Answer 10

• FBC
• infection - CRP/EPR
• metabolic - thyroid, vit b12 deficiency

Question 11

Risk factors

Answer 11

• smoking
• female
• environmental- living above 40 degrees altitude in the northern hemisphere
• infection - EBV
• vit d defiency

Question 12

In general what is the key for diagnosis

Answer 12

Lesions in at least 2 areas of the CNS or optic nerve

Question 13

A diagnosis for PPSC

Answer 13

A hx of progressive deterioration over 24 months or more

Question 14

A diagnosis for RRSC

Answer 14

A good hx showing lesions have developed in different areas at different times

Question 15

Which test can detect defects CNS demyelinsation

And what can lumbar puncture reveal

Answer 15

MRI

Reveal oligoclonal bands - indicating CNS inflammation

Question 16

Management strategies

Answer 16

Contraceptives in women

AVOID live vaccines - risk of relapse

Question 17

Treatment is called DMT - disease modifying therapy - list the names of the drugs

Answer 17

Interferon bat 1a and 1b

Glatiramer acetate

Mitroxantrone

Natalizumab

Fingolimod

Teriflunomide

Question 18

What is the main object of the DMT

Answer 18

Decrease severity and frequency of relapse + accumulation of lesions

Question 19

Interferon beta 1a and 1b

Answer 19

Increases suppressor T cell function

Question 20

Glatiramer acetate

Answer 20

Stimulates myelin protein

Question 21

Mitroxantrone

Answer 21

Chemo drug

Suppressors T cells, B cells and macrophages

Question 22

Natalizumab

Answer 22

A monoclonal antibody which stops the movement of T cells across BBB

Question 23

Fingolimod

Answer 23

S1P receptor modulator- inhibiting accumulation of lymphoctyes - decreasing inflammation in the CNS

Question 24

Teriflunomide

Answer 24

Pyrimidine synthesis inhibitor, reducing T and B cell proliferation

Question 25

Which of the drugs is an anti-lymphocytes monoclonal antibodiy

Answer 25

Natalizumab

Question 26

Which drug needs a ECG and PB check before starting

Answer 26

Fingolimod

Question 27

Now management of symptoms

Question 28

Management of relapse?

Answer 28

Oral Methylprednisolone Or IV

Question 29

Management of spasticity

Answer 29

• 1st baclofen • 2nd gabapentin • 3rd together

Question 30

Fatigue/impairmed mobility

Answer 30

Amantadine - for fatigue Mofafinil- sleepiness SSRIs

Question 31

Oscillopsia vision (when you think your environment is moving around)

Answer 31

1st gabapentin 2nd memantine

Question 32

Walking dysfunction

Answer 32

Fampridine (but nice doesn’t recommended it because expensive)

Question 33

Dalfampridine is used for treating walking dysfunction what is the moa?

Answer 33

Inhibits K channels

Question 34

Dalfampridine ADR

Answer 34

Sezuires

Question 35

What is first line management for RRMS

Answer 35

Interferon beta If fails then - monoclonal antibodies

Question 36

Most common side effect of Interferon beta

Answer 36

Flu like symptoms

Question 37

What form does Interferon beta come in

Answer 37

IM and SC

Question 38

Common ADR of fingolimod

Answer 38

Bradycardia

Question 39

True or false Risk of relapse decreases during pregnancy

Answer 39

TRUE

Question 40

What advise would you give to pregnant women on MS treatment

Answer 40

Use effective contraception Avoid pregnancy during treatment Pregnancy test before starting treatment