Multiple sclerosis

Question 1

what is multiple sclerosis?

Answer 1

inflammatory condition of the central nervous system

Question 2

it is progressive demyelination of typical areas of ———— matter within the brain and spinal cord?

Answer 2

white

Question 3

due to the limited capacity for re-myelination of axons this leads to defects in?

Answer 3

the rate and consistency of neuronal conduction

Question 4

demyelination of white matter can occur

Answer 4

anywhere in the CNS

Question 5

what is the most common phenotype of MS?

Answer 5

relapsing and remitting

Question 6

what are plaques?

Answer 6

areas of demyelination

Question 7

what is indicative of ongoing demyelination and inflammation?

Answer 7

active plaques

Question 8

what is indicative or a burnt out active plaque?

Answer 8

inactive plaques

Question 9

where are the common areas of demyelination? (4)

Answer 9

corpus callosum
optic nerve
periventricular white matter
cerebellar white matter

Question 10

what are risk factors for developing MS? (5)

Answer 10

living in areas of higher latitude 
previous EBV infection 
1st degree relative with MS 
Presence of HLA DRB1 
common in young females

Question 11

what is the presesntation of pyramidal dysfunction in mS?

Answer 11

features of upper motor neurone dysfunction

tonic spasms

Question 12

what are examples of upper motor neurone dysfunction?

Answer 12

spasticity, weeakness, hyper-reflexia

Question 13

where do upper motor neurone dysfunction tend to occur?

Answer 13

extensors of the upper limb and flexors of the lower limb

Question 14

what type of tonic spasms are associated with MS?

Answer 14

frequent biref spasms of the lower limb

Question 15

what is the preesentation of optic neuritis?

Answer 15

painful eye movements or visual loss

colour desaturation, loss of visual acuity

Question 16

what is seeen in the swinging light test?

Answer 16

RAPD

Question 17

what is seen on fundoscopy?

Answer 17

pale optic disc

Question 18

what is a manifestation of brainstem demyelination affecting the medial longitudinal fasiculus on one or both sides?

Answer 18

internucleur ophtaahlmoplegia

Question 19

what does INO cause?

Answer 19

horizontal diplopia

Question 20

if you have a right INO

Answer 20

there is inability to adduct the right eye and a nystagmus of the left eye on attempted horizontal gaze to the left

Question 21

what is pathognomonic of MS?

Answer 21

bilateral INO

Question 22

there is a sensaation of ——– trickling down one’s skin

Answer 22

water

Question 23

loss of sensation of DCLM tract manifested by?

Answer 23

clumsinesss due to loss of proprioception

Question 24

in regards to trigeminal neuralgia what is important to pay attention to?

Answer 24

bilateral attacks, on both sides of the face

Question 25

what is Lhermitte's sign?

Answer 25

electric shock-like seensation down the upper limbs and trunk on neck flexion

Question 26

what is Uhthoff's phenomenon?

Answer 26

exacerbation of current symptoms in hor environments - i.e. after a hot shower

Question 27

electric shock-like seensation down the upper limbs and trunk on neck flexion

Answer 27

Lhermitte's sign

Question 28

exacerbation of current symptoms in hor environments - i.e. after a hot shower

Answer 28

Uhthoff's phenomenon

Question 29

what are the symptoms of cerebellar dysfunction?

Answer 29

``` dysdiodochokinesia ataxia nystagmus intention tremor slurred speech hypotonia ```

Question 30

what type of incontinence is associated with MS?

Answer 30

urge incontinence , retention

Question 31

how do you diagnose MS?

Answer 31

evidence of two distinct neurological deficits occuring at different tyimes implicating lesions of white matter which are spatially and functionally distinct

Question 32

what two tools can be used to confirm MS?

Answer 32

MRI imaging and CSF analysis

Question 33

what is seen on MRI imaging of MS?

Answer 33

multiple white matter plaques

Question 34

what is seen in CSF of MS?

Answer 34

presence of IgG Oligoclonal bands

Question 35

how do you manage mild acute relapse?

Answer 35

symptomatic treatment

Question 36

how do you manage moderate acute relapse?

Answer 36

oral prednisolone

Question 37

relapse rates may --------- during pregnancy and may -------------- 3–6 months after childbirth before returning to pre‑pregnancy rates

Answer 37

reduce | increase

Question 38

there is a possible risk of ------------- following flu vaccination if they relapse and remitting MS?

Answer 38

the possible risk of relapse after flu vaccination

Question 39

encourage people with ms to?

Answer 39

exercise

Question 40

what is the 1st line DMARD for relapsing-remitting disease? (3)

Answer 40

Tecfidera, Beta-interferon or Glatiramer Acetate

Question 41

where 1st line therapy with DMARD has failed to control disease activity the following can be used? (3)

Answer 41

Tysabri (Natalizumab) | Fingolimod

Question 42

what is natalizumab?

Answer 42

monoclonal antibody

Question 43

what is the risk of tysabri?

Answer 43

risk of progressive multifocal leukoencephalopathy via JC infection

Question 44

what type of DMARD is fingolimod?

Answer 44

sphingosine-1-phosphate inhibitor

Question 45

when is Ocrelizumab used?

Answer 45

1st line in early primary progressive MS only

Question 46

how do you manage spasticity?

Answer 46

physiotherapy and oral baclofen/gabapentin

Question 47

how do you manage neuropathic pain?

Answer 47

gabapentin

Question 48

how do you maanage fatigue?

Answer 48

amantadine +/- modafinil if excessive daytime sleepiness

Question 49

how do you manage bladder dysfunction?

Answer 49

bladder physiotherapy, cathterisation in cases of retention and anticholinergic drugs (oxybutynin) in cases of urgee incontinence

Question 50

what type of hypersensitivity reaction is MS?

Answer 50

type IV mediated or cell mediated hypersensitivity

Question 51

what is charcot's neurological triad?

Answer 51

Dysarthria intention tremor nystagmus