Multiple Sclerosis

Question 1

immune mediated destruction of CNS w/ secondary loss of axons

Answer 1

MS

Question 2

classic MS lesion

Answer 2

demarcated white matter plaques, have a periventricular prominence

Question 3

initial step in pathogenesis

Answer 3

lymphocytes and macs penetrate BBB

Question 4

MS vs other leukodystrophies (demyelinating dzs)

Answer 4

MS gives autoimmune destruction of myelin

leukodystrophies have abnl myelin produced (defective synthesis)

Question 5

MS affects people from what location

Answer 5

born and raised in temperate latitudes or global zones father from the equator (maybe related to lower vit D levels?)

Question 6

“risk factors” for MS

Answer 6

genetically susceptible
exposure to triggering factors (maybe virus)
live in temperate zones

Question 7

amount of inc risk for siblings of MS patient

Answer 7

20-fold inc risk

Question 8

MS population

Answer 8

young adults 20-40 y/o

Question 9

F:M ratio for MS

Answer 9

2:1

Question 10

first course of MS

Answer 10

80% relapsing-remitting

20% primary progressive

Question 11

2nd phase for MS pts who started relapsing-remitting

Answer 11

secondary progressive phase - less recovery

Question 12

primary progressive MS pathogenesis

Answer 12

different from relapsing-remitting type, doesn’t respond well to immunomodulators

Question 13

cause of death for MS

Answer 13

infection, malnutrition, and pulm emboli –> complications of immobility

Question 14

initial sxs of MS

Answer 14

optic neuritis, sensory/motor deficits in lower limbs, internuclear opthalmoplegia

Question 15

MLF lesion

Answer 15

aka internuc opthalmoplegia - blurry vision/diplopia

Question 16

Lhermitte’s sign is due to

Answer 16

due to short circuiting w/in posterior columns of C spine from MS plaques, Vit B12 deficiency, or compression of spinal cord

Question 17

electric shock/tingling down spine into arms/legs provoked by neck flexion

Answer 17

Lhermitte’s sign

Question 18

MS “attack”

Answer 18

aka relapse/exacerbation
lasts 24+ hrs
no fever/infection

Question 19

MS pseudo-exacerbation

Answer 19

looks like recurrence but is due to infection (inc temp causes impaired depol/conduction thru a remyelinated region)

Question 20

historic dx for MS

Answer 20

sxs disseminated in time and space w/ no other identifiable cause

Question 21

current dx for MS

Answer 21

use MRI (high sensitivity, but not specific, for white matter lesions)

Question 22

monophasic mimics of MS (aren’t “disseminated in time”)

Answer 22

post-infectious encephalomyelitis

Question 23

aging of lesions via MRI

Answer 23

acute/new lesions enhance (inflamm), chronic/inactive lesions don’t enhance

Question 24

CSF for MS

Answer 24

oligoclonal bands

inc Ig synthesis

Question 25

MS evoked potentials

Answer 25

delayed cortical response to stimuli

Question 26

MS tx for acute aggressive attack

Answer 26

IV high dose steroids (methylpred 500-1000 mg/day x 3-5 days +/- prednisone taper)

Question 27

method to"help prevent "MS flare" sxs

Answer 27

fever control

Question 28

tx to reduce severity/frequency of MS attacks

Answer 28

DMT - beta IFN or glatiramer acetate

Question 29

protein that inc suppressor T cell fxn, dec lymphocytes entering CNS, dec antigen presentation, dec cytokine production

Answer 29

beta IFN

Question 30

Betaseron

Answer 30

IFN beta-1b | subq injection every other day

Question 31

Avonex

Answer 31

IFN beta-1a given IM weekly

Question 32

Rebif

Answer 32

IFN beta-1a given subq 3x/wk

Question 33

Glatiramer acetate (aka Copaxone)

Answer 33

polypeptide resembling myelin basic protein (byproduct of myelin destruction) , given subq daily

Question 34

MS tx to dec limb spasticity

Answer 34

Dilfampridine (4-aminopyridine)

Question 35

Dilfampridine (4-aminopyridine)

Answer 35

K channel blocker | inc walking speed

Question 36

Natalizumab (Tysabri)

Answer 36

interferes w/ binding of lymphocytes to CNS vasc cell adhesion machines

Question 37

complication of Natalizumab

Answer 37

reactivation of JC virus

Question 38

other oral meds for MS

Answer 38

fingolimod (Gilenya), teriflunomide (Aubagio) and dimethyl fumarate (Tecfidera)