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Block 8 Week 5 Colt > MS - Bloch > Flashcards

MS - Bloch Flashcards

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1
Q

Where is there a greater geographic risk of MS?

A

the farther away from the equator; Reno and farthernorth

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2
Q

What two groups of people never get MS?

A

Inuits and Laplanders of Northern Scandinavia

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3
Q

Less sun exposure leads to a (higher/lower) risk of MS

A

higher

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4
Q

How many times more likely are women to get MS?

A

2-3x

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5
Q

when do women usually get their first MS attack/

A

after first pregnancy; espcially after nursing as the hormones affect the immune system

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6
Q

How long is a cancer Dx postponed in pts with MS?

A

10 years

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7
Q

What vitamin has a huge protective factor against MS?

A

vitamin D; >20 minutes of sun per day

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8
Q

what are the symptoms of MS?

A 
severe pain under eye (has moved to eye)
blurry vision
memory problems
FATIGUE
leg numbness
hip pain indicates spinal lesion
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9
Q

when is MS onset most common?

A

20s-30s

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10
Q

Describe the MOA of MS?

A

WBCs see myelin as foreign, cross the BBB and cause white matter lesions

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11
Q

Why is optic neuritis a common manifestation of MS?

A

high vascularization leads to larger WBC deposition

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12
Q

What percent of pts progress from optic neuritis to MS?

A

90%

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13
Q

T/F: DMARDS should be started at the time of the first MS attack

A

true

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14
Q

T/F: MS is more common with other autoimmune presentation

A

true

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15
Q

What are the side effects of betaseron (IFN)?

A

fatigue and flu like sx

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16
Q

By what percent does betaseron reduce the relapse rate of MS?

A

30%

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17
Q

What are the side effects of copaxone?

A

welts and liponecrosis

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18
Q

What is the MOA of copaxone?

A

co-polymer with unknown MOA; thought to maybe create a protective layer that makes it harder for WBCs to attack

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19
Q

What is the first oral DRMARD?

A

Fingolimide

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20
Q

What is the MOA of fingolimide?

A

sphingosoine receptor agonist

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21
Q

which cells have sphingosine receptors?

A

T cells

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22
Q

What happens with fingolimide attaches to T cells?

A

enter lymph nodes and never leave; no WBC circulation

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23
Q

What are the side effects of fingolimide?

A

heart
BP
eye

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24
Q

By what percent does fingolimide reduce relapse rates/

A

50%

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25
What is the most effective drug in MS?
Tysabri
26
what is the MOA of tysabri?
prevents T cells from crossing the BBB
27
by what percent does tysabri reduce relapse rates?
70%
28
What are the issues that present after being on tysbri for 2 years or more?
increased risk of certain infections | increased reactivation of the John Cunningham virus (leads to PML progressive multifocoal leukoencephalopathy)
29
In which group of pts on tysabri will get PML from a JC virus reactivation/
HIV or chemo pts
30
T/F: you can develop allergies to tysabri and IFN treatment
true
31
T/F: life expectancy is now normal in pts with MS
true
32
MS is associated with which HLA protein?
HLA-DR2
33
what are some of the proinflammatory neurotoxic factors?
``` TH1 and TH17 cytokines TNF IL-1 osteopontin leukotrienes MMP plasminogen activators nitric oxide reactive oxygen species glutamate antibody + complement cell-mediated cytotoxicity neurotrophins via p75NTR? ```
34
what are the anti-inflammatory and neuroprotective factors?
``` TH2 cytokines TGF-beta soluble TNF receptor soluble IL-1 receptor IL-1 receptor antagonist some prostaglandins lipoxins TIMP antithrombin ***BDNF NGF NT3 neurotrophic NT4/5 factors GDNF LIF *** ```
35
In MS, (blank) type cytokines predominate
proinflammatory
36
Active inflammation has what two destructive effects on neurons?
demyelination | axonal transectoin
37
at what age do you normally get MS?
between 20 and 50; Dx in young kids and older adults; women:men 2-3:1
38
What ethnicity gets MS more often?
N. european; more common in caucasians than hispanics or African americanns; RARE IN ASIANS
39
MS is more common in which biome?
temperate climes
40
what percent of people with MS have a blood relative with MS?
20%
41
What are multiplex families?
there is a higher risk in families in which there are multiple family members with MS
42
Is MS a clinical or lab Dx?
clinical
43
What are the paraclinical tests that support an MS dx?
MRI spinal fluid evoked potentials
44
What are the Dx criteria for MS?
dissemination in time and space: evidence that damage has occurred in two separate areas of the CNS at diff. pts in time
45
What is the workup up order for Dx of MS?
1. MRI with gadolinium 2. Potential MS mimetics rule out (blood testing) 3. LP (OBs and/or elevated IgG index or synth) 4. Evoked potentials
46
What is clinically isolated syndrome?
first neuro event suggestive of demyelination; at high risk for developing MS if multiple silent lesions on MRi
47
What are the two most common types of CIS?
optic neuritis | transverse myelitis
48
What are the Sx of optic neuritis?
Sudden, but transient loss of visual acuity Unilateral or bilateral Retro-orbital pain exacerbated by eye movement Normal optic disc Reduced color perception Decreased vision following activities that elevate body temperature
49
what are the Sx of transverse myelitis?
Ascending numbness from the feet, up the torso, potentially from hands to arms Ataxia, balance problems Electric shock sensations while flexing neck Partial or complete paralysis Bladder dysfunction Bowel dysfunction Sexual dysfunction
50
On MRI, what is the strongest correlation with progression of disability?
T1 precontrast black holes; shows axonal loss
51
what do you see on T1 gadolinium post contrast MRI?
white spots that show active BBB breakdown
52
What do you see on FLAIR MRI?
MS lesions as white spots
53
What do you see on T2 MRI?
the spinal fluid and the lesions both show up as white so its harder to tell what the fuck is going on
54
Which DMARDS are approved for relapsing forms of MS?
``` IFNb-1b IFNb-1a IM and SC Fingolimod dimethyl fumarate Tysabri **as monotherapy** ```
55
Why are tysabri and mitonaxotrone second line therapy?
safety concerns even though they are better tolerated
56
which DMARD is a humanized Mab?
tysabri
57
what type of MS is copaxone approve for?
relapsing-remitting MS
58
What are the negative prognostic indicators for MS?
``` Frequent, multifocal attacks Heavy MRI burden on initial scans Pyramidal involvement Ataxia Cognitive difficulties 5 year accumulation of disability Spinal progression (primary progressive MS) ```
59
What is the immediate Tx for a relapse?
corticosteroids if it sig. interferes with ADLs | Rehab if necessary
60
how do you define a relapse?
new neuro symptom lasting 24 hours or worsening of old symptom
61
What is the most common MS symptom?
fatigue
62
What are the "visible" symptoms of MS?
``` Spasticity Gait, balance, and coordination problems Speech/swallowing problems Tremor Weakness ```
63
What drug is approved to increase walking speed in MS?
Dalfampridine; oral K channel blocker that speeds nerve conduction
64
T/F: sensitivity to heat or cold can happen in MS
true; but heat is more common
65
How does an infection worsen MS symptoms
through raising the body temp
66
What's an easy way to tell if someone is having a true relapse or a pseudoexacerbation?
urine screen for a UTI
67
What druugs can you give to treat the "small bladder" in MS?
oxybutynin Tolteridine trospium chloride
68
what drugs can you give to treat the "large bladder" in MS?
stimulating meds | intermittent self-catheterization
69
What drugs can you give to treat the dysynergic bladder?
Alpha adrenergic agonists like dibenzyline, terazosin ,Cardura, and put in a catheter
70
What can you give to treat nocturia?
DDAVP- desmopressin
71
What drugs can you give to manage MS pain?
``` gabapentin lamotrigine carbamazepine amitriptyline pregabalin ```
72
what kind of pain is MS pain?
burning, irritating, neuropathic pain
73
What psych disorder is often confused with MS symptoms?
depresssion; it is UNDER Dx'd and treated
74
What is the Tx for MS and depression?
Psychotherapy, meds, and exercise
75
what percent of people with MS will experience an MDD?
greater than 50%
76
suicide is how many more times common in MS pts?
7.5x
77
T/F: cognitive impairment is common in MS
false!!; only occurs in late or severe stages
78
Because MS is a white matter disease it does not effect what three architectural properties of the brain?
1. brain volume 2. gray matter 3. cerebral cortex
79
What are the causes for memory problems in MS?
stress anxiety depression
80
Cogntive function correlates with...
lesion load and brain atrophy
81
T/F: cognitive dysfunction can occur as a first symptom in MS
true; although it normally happens later on; most common PROGRESSIVE MS
82
T/F: depression can worsen cognition
true

Block 8 Week 5 Colt (12 decks)

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