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Y3 NEUROLOGY > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

Inflammatory neurodegenerative demyelinating disorder of the white matter in the CNS involving deposition of plaques

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2
Q

Males are more commonly affected by MS than females. True/False?

A

False

Females 3:1 males

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3
Q

List the 4 classifications of MS (in order of decreasing disability)

A

Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive

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4
Q

Which classification of MS is the most common?

A

Relapsing remitting

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5
Q

List clinical features of MS

A 
Pyramidal dysfunction
Optic neuritis/ VISUAL SYMPTOMS
Sensory dysfunction
Lower urinary tract dysfunction
Cognitive impairment
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6
Q

List features of pyramidal dysfunction that can occur in MS

A 
Hypertonia (STIFFNESS)
WEAKNESS
Spasticity
Weakness of extensors of upper limbs
Weakness of flexors of lower limbs
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7
Q

List features of sensory dysfunction that can occur in MS

A 
Paraesthesia
Pain
Proprioception and vibration deficit
Numbness
Trigeminal neuralgia
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8
Q

List features of cerebellar dysfunction that can occur in MS

A 
Ataxia
Intention tremor
Nystagmus
Past pointing
Pendular/floppy reflexes
Dysdiadokinesis
Dysarthria
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9
Q

What is internuclear ophthalmoplegia?

A

Defect in medial longitudinal fasciculus resulting in nystagmus in an abducting eye + lag/failure in adducting eye (diplopia)

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10
Q

List lower urinary tract features of MS

A 
Frequency
Nocturia
Urgency
Urge incontinence
Retention
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11
Q

What therapy can be given for fatigue in MS?

A

Amantadine

Modafinil if epilepsy or sleepy

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12
Q

What investigations can be done for MS?

A

MRI with gadolinum contrast
CSF
Neurophysiology
Blood tests

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13
Q

Blood tests are usually normal in MS. True/False? What blood tests should be requested?

A

True
Plasma viscosity, FBC, CRP, renal liver bone profile, autoantibody screen, borellia, HIV, sypillus serology, B12 and folate

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14
Q

What is the name given to the protein bands present on CSF electrophoresis in MS?

A

Oligoclonal bands - typically not similar

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15
Q

Outline treatment for acute exacerbation of MS (mild, mod, severe)

A

Mild: symptom relief
Mod: oral steroid
Sev: IV steroid

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16
Q

What therapy can help spasticity?

A

Physiotherapy
Anti-spasmodic (baclofen)
Botox

17
Q

What therapy can help sensory symptoms?

A 
Gabapentin (anticonvulsants)
Amitryptiline (antidepressants)
TENS
Acupuncture
Lignocaine (last-resort)
18
Q

List 1st-line disease-modifying therapy for MS

A

Interferon-beta (avonex, extavia, rebif, betaseron)
Copaxone
Tecfidira

19
Q

List 2nd-line disease-modifying therapy for MS

A 
Monoclonal antibody (tysabri, lemtrada, zymbrota)
Fingolimod
20
Q

What age range is the onset of MS most common?

A

30s - 40s

21
Q

List features of brainstem dysfunction that can occur in MS

A 
Diplopia (VI palsy)
Facial weakness (VII palsy)
22
Q

List clinical signs of optic neuritis

A

Painful loss of vision
Blurred vision
Loss of colour vision
RAPD (central scotoma)

23
Q

What clinical sign on MRI must be present to diagnose MS?

A

Evidence of dissemination of inflammatory plaques in white matter in time and place (damage at different rates and to different parts of CNS)

24
Q

In order to diagnose MS, there must be at least ___ episodes suggestive of demyelination

A

2

25
Q

List some differential diagnoses for MS

A 
Vasculitis
Granulomatous disorder
Vascular disease
Structural lesion
Infection
Metabolic disorder
26
Q

What are the common causes of lower UT dysfunction in MS?

A

Increased tone at bladder neck
Detruser hypersensitivity
Detruser syphincteric dysnergia

27
Q

Outline the treatment options for lower UT dysfunction in MS

A

Bladder drill
Oxybutynin (anticholinergic)
Desmopressin
Catheterisation

28
Q

Which drug is first line in relapsing remitting MS?

A

Tecfedira

29
Q

What is the indication for adding a monoclonal antibody to treatment?

A

Severe, rapidly evolving RR MS

High disease activity and on IFN

30
Q

List a 3rd-line disease-modifying therapy for MS

A

Mitoxantrone

31
Q

Which monoclonal antibody is used in early primary progressive MS?

A

Ocrelizumab

32
Q

Outline the inflammatory cascade in MS

A
  1. Immune cells pass through BBB
  2. Immune cells may reactivate and produce cytokines
  3. Immune cells mount A1 attack against myelin
33
Q

Outline the aetiology of MS, in two categories

A

ENVIRONMENT: latitude, vitamin D def, viral (EBV)
GENETIC: gene HLA DR2

34
Q

Outline the management of optic neuritis

A

IV methylprednisolone

Oral prednisolone

Y3 NEUROLOGY (22 decks)

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