Multiple sclerosis

Question 1

single episode of MS is called

Answer 1

clinically isolated syndrome of CNS demyelination

Question 2

balance worse in the dark or when they are not looking at their feet

Answer 2

sensory ataxia

Question 3

electric shock like sensation radiating down and up the spinal cord, provoked by flexion + extension of the neck, accompanied by paraesthesia in arms, legs, abdomen

Answer 3

L’Hermitte’s phenomenon

Question 4

when to give MS disease modifying treatment

Answer 4

Patients experiencing 2 or more significant relapses over a 2 year period

Question 5

what contrast material is injected prior to MRI brain to highlight areas of brain with active or recent inflammation

Answer 5

Gadolinium

Question 6

management of secondary progressive MS

Answer 6

Betaferon: disease modifying drug

Question 7

symptomatic treatment of Spasticity

Answer 7

Baclofen

Question 8

symptomatic treatment of neuropathic pain

Answer 8

Gabapentin (anticonvulsant drug)

Question 9

management of depressive symptoms in MS

Answer 9

sertraline

Question 10

management of neuropathic bladder (urinary urgency + frequency)

Answer 10

Oxybutinin (anticholinergic drug)

Question 11

how to assess amount of residual urine in bladder

Answer 11

ultrasound of bladder

Question 12

MDT for MS

Answer 12

• physiotherapist
• occupational therapist
• language therapist
• neurorehabilitation consultant
• MS specialist nurse

Question 13

what is MS

Answer 13

autoimmune disease that affects the CNS

Question 14

women:men incidence

Answer 14

3:1

Question 15

MS age affected

Answer 15

20-40 years old

Question 16

relationship between equator and MS

Answer 16

the further away from the equator, lower the levels of Vit D and higher the incidence of MS

Question 17

symptoms of optic neuritis

Answer 17

• blurred vision
• pain on eye movement
• colour desaturation

Question 18

Uhthoff’s phenomenon is

Answer 18

visual fatigue as the nerve is not functioning as good as before due to excessive use of vision… may experience this with optic neuronitis

Question 19

inflammation within cerebral hemispheres

Answer 19

fatigue, weakness, sensory disturbance

Question 20

Cerebellar lesion

Answer 20

• slurred speech
• ataxia
• incoordination

Question 21

spinal cord inflammation symptoms

Answer 21

• weakness
• sensory disturbance
• autonomic dysfunction

Question 22

urinary features of spinal cord inflammation

Answer 22

incontinence, urgency, hesistency

Question 23

pathophysiology of MS

Answer 23

demyelination along a nerve; the impulse is delayed and can also be blocked

Question 24

4 types of MS

Answer 24

• relapsing-remitting
• secondary progressive
• primary progressive
• progressive-relapsing

Question 25

what is secondary progressive MS?

Answer 25

after around 15 years of having relapsing-remitting MS, patients can have hardly any relapses and progressively worsen, with or without attacks

Question 26

85-90% of MS is

Answer 26

relapsing-remitting MS

Question 27

Investigations in MS

Answer 27

LP, MRI

Question 28

how long do acute attacks last

Answer 28

varies, | 1-2 months

Question 29

LP findings in MS

Answer 29

- protein < 1 gram | - oligoclonal bands

Question 30

4 MS mimics

Answer 30

- Anticardiolipin antibody syndrome - Neuromyelitis optica/Devic's syndrome - Neurosarcoidosis - Sjogren's syndrome

Question 31

what is Anticardiolipin antibody syndrome

Answer 31

inflammatory disease that can cause lesions in the CNS similar to MS

Question 32

what is Neuromyelitis optica

Answer 32

inflammatory disorder of the CNS that causes longitudinally extensive transverse myelitis

Question 33

transverse myelitis on MRI scan

Answer 33

inflammation spanning > 3 vertebral segments on MRI

Question 34

Treatment of acute relapses

Answer 34

High dose steroids (oral/IV methylprednisolone) | for 5 days