Matthew Coulson
Quiz by , created more than 1 year ago

Multiple Sclerosis lectures (Parts 1 & 2) given on 18/09/2018 https://en.wikipedia.org/wiki/Multiple_sclerosis_signs_and_symptoms#Internuclear_ophthalmoplegia is really good for a walkthrough of MS symptoms

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Matthew Coulson
Created by Matthew Coulson over 5 years ago
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Multiple Sclerosis - Presentation, Diagnosis & Management

Question 1 of 36

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Multiple Sclerosis is a condition whereby the ( myelin sheathes, axons, cell bodies, dendrites ) of ( CNS tracts, PNS neurons ) are broken down. Lesions also appear in the ( CNS, PNS ), and these are referred to as ( plaques, cysts, aggregates ).

Explanation

Question 2 of 36

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Multiple Sclerosis affects ( only CNS tracts, only PNS neurons, both CNS tracts and PNS neurons )

Explanation

Question 3 of 36

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Multiple Sclerosis is more prevalent in ...

Select one of the following:

  • Females

  • Males

Explanation

Question 4 of 36

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Multiple Sclerosis tends to initially present ...

Select one of the following:

  • in the teens

  • between 30 and 40 years of age

  • in those over 50 years of age

Explanation

Question 5 of 36

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To be specific, Multiple Sclerosis is the loss of the cells that produce myelin in the CNS, known as

Explanation

Question 6 of 36

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Multiple Sclerosis tends to cause pyramidal dysfunction. This can cause such things as spasticity, weakness and increased tone. What is the main tract of the pyramidal tract group?

Explanation

Question 7 of 36

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The pyramidal dysfunction associated with Multiple Sclerosis tends to cause spasticity/weakness/etc to the ( extensors, flexors ) of the upper limbs and the ( flexors, extensors ) of the lower limbs

Explanation

Question 8 of 36

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Which visual condition is present in 50% of MS sufferers, and is the first sign of MS in 20% of sufferers?

Explanation

Question 9 of 36

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How does Optic Neuritis present? (2 right answers)

Select one or more of the following:

  • Acute onset pain in eye upon eye movement

  • Central blurriness/visual loss

  • Peripheral blurriness/visual loss

  • Red eye

  • Floaters in visual field

Explanation

Question 10 of 36

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In most cases, optic neuritis is a self-resolving condition given a few months.

Select one of the following:

  • True
  • False

Explanation

Question 11 of 36

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Some multiple sclerosis patients describe an intense pain of the face that can be triggered simply by light touch of the face. This condition is typically caused by impingement of one of the cranial nerves by a blood vessel, and is called .

Explanation

Question 12 of 36

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Trigeminal Neuralgia only tends to affect 2-4% of MS patients. These patients are typically treated using an anticonvulsant called

Select one of the following:

  • Sodium Valproate

  • Carbamazepine

  • Lamotrigine

  • Acetazolamide

  • Diazepam

Explanation

Question 13 of 36

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What are the main two cerebellar manifestations of Multiple Sclerosis?

Select one or more of the following:

  • Ataxia

  • Tremor

  • Slurred speech

  • Dizziness

  • Headaches

Explanation

Question 14 of 36

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Multiple Sclerosis can cause CNVI palsy. How would this present?

Select one of the following:

  • Inability to abduct the eyes, causing diplopia

  • Inability to gaze downwards, causing diplopia

  • Negative pupillary light reflex

Explanation

Question 15 of 36

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In addition to this, Multiple Sclerosis can also cause difficulty in adduction of the eyes. This occurs when a plaque forms in the Medial Longitudinal Fasciculus and presents as Nystagmus of the ( abducting, adducting ) eye and is called ( Internuclear Ophthalmoplegia, Chronic Progressive Ophthalmoplegia, Internal Ophthalmoplegia )

Explanation

Question 16 of 36

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70-80% of Multiple Sclerosis sufferers have lower urinary tract problems. The most common are ( increased, decreased ) frequency and ( urge, stress, overflow ) incontinence.

Explanation

Question 17 of 36

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Amantadine is a drug commonly prescribed to Multiple Sclerosis patients suffering from

Select one of the following:

  • Fatigue

  • Speech Impairment

  • Sexual Issues

  • Emotional Issues (e.g. Depression)

Explanation

Question 18 of 36

1

For a diagnosis of Multiple Sclerosis to be confirmed, the patient must have suffered at least 2 episodes suggestive of demyelination.

Select one of the following:

  • True
  • False

Explanation

Question 19 of 36

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Name the criteria typically used to diagnose multiple sclerosis.
The Criteria

Explanation

Question 20 of 36

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Which imaging study should be conducted in order to diagnose Multiple Sclerosis?

Select one of the following:

  • MRI

  • CT

  • X-ray

Explanation

Question 21 of 36

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Multiple Sclerosis may also be diagnosed by means of lumbar puncture to look for inflammation in the CNS. The CSF is tested for oligoclonal bands of ( IgG, IgA, IgE ) on electrophoresis, which are inflammation markers found in 75–85% of people with Multiple Sclerosis.

Explanation

Question 22 of 36

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In the most basic sense, acute exacerbations of multiple sclerosis are treated by the following:
Mild: ( Symptomatic treatment, Watchful waiting, No treatment )
Moderate: ( Oral steroids, Oral anticonvulsants, Oral antidepressants )
Severe: Admit & give ( IV Steroids, IV Anticonvulsants, IV Antiepileptics )

Explanation

Question 23 of 36

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Baclofen is a medication used to treat ... in MS patients

Select one of the following:

  • Spasticity

  • Sensory Symptoms

  • Lower Urinary Tract Dysfunction

  • Fatigue

Explanation

Question 24 of 36

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Sensory symptoms caused by MS (pain, paraesthesia, numbness, etc) can be treated by the following:
Anti convulsant, e.g.
Anti depressant, e.g.

Drag and drop to complete the text.

    Gabapentin
    Amitriptyline
    Amantadine

Explanation

Question 25 of 36

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The lower urinary tract dysfunction caused by multiple sclerosis can be treated by a Vasopressin Analogue called ...

Select one of the following:

  • Desmopressin

  • Terlipressin

  • Carbopressin

Explanation

Question 26 of 36

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Despite this, the most common long term management of lower urinary tract dysfunction in multiple sclerosis patients is...

Select one of the following:

  • Pelvic floor muscle training

  • Catheterisation

  • Anticholinergics e.g. Oxybutynin

Explanation

Question 27 of 36

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If an individual is thought to be at risk of developing MS or has two relapses of the condition, disease modifying therapy can be prescribed.
Match each first line therapy to it's description.
: Balances expression of pro- and anti-inflammatory agents in the brain & reduces number of inflammatory cells crossing the blood brain barrier.
: Shifts the population of T cells from pro-inflammatory Th1 T-cells to regulatory Th2 T-cells that suppress the inflammatory response.

Drag and drop to complete the text.

    Interferon Beta
    Glitiramer Acetate
    Interferon Gamma

Explanation

Question 28 of 36

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How are Interferon Beta & Glitiramer Acetate (Copaxone) administered in MS patients?

Select one of the following:

  • Subcutaneous/Intramuscular

  • Intravenous

  • Sublingual

  • Oral

Explanation

Question 29 of 36

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In patients with highly active multiple sclerosis, whereby interferon beta and Copaxone are ineffective, what is the second line disease modifying agent that should be given?

Select one of the following:

  • Fingolimod

  • Mitoxantrone

Explanation

Question 30 of 36

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Second line treatment can also come in the rather expensive form of monoclonal antibodies. Drugs such as Natalizumab are able to reduce the ability of inflammatory immune cells to attach to and pass through the cell layers lining the

Select one of the following:

  • Blood-brain barrier

  • White matter tracts of the brain (e.g. internal capsule)

  • Grey matter areas of the brain affected by MS such as the basal ganglia

  • myelin sheathes of CNS tracts

Explanation

Question 31 of 36

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The presence of which Human Leukocyte Antigen predisposes to multiple sclerosis?

Select one of the following:

  • HLA B27

  • HLA DR2

  • HLA D45

  • HLA BR7

Explanation

Question 32 of 36

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Which type of multiple sclerosis is the most common?

Select one of the following:

  • Relapsing Remitting

  • Primary Progressive

  • Secondary Progressive

  • Progressive Relapsing

Explanation

Question 33 of 36

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Match the MS types to its definition:
= Bouts of disease which occur months/years apart. Between these bouts there is no worsening in the patient's disability.
= Starts like relapsing remitting however then becomes a linear, constant attack on the myelin.
= A constant attack on the myelin of the CNS - no bouts, just a constant disease state.
= Bouts of disease which occur months/years apart. Between these bouts there is a progressive worsening of the condition.

Drag and drop to complete the text.

    Progressive Relapsing
    Primary Progressive MS
    Secondary Progressive MS
    Relapsing Remitting MS

Explanation

Question 34 of 36

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Charcot's triad is indicative of Multiple Sclerosis. This consists of ...

Select one or more of the following:

  • Dysarthria

  • Nystagmus

  • Intention Tremor

  • Chorea

  • Myoclonus

  • Lhermitte's Sign

  • Incontinence

Explanation

Question 35 of 36

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sign = Electric shock-like jerk which potentiates down the spine and radiates into the limbs when an individual bends their neck forwards.

Explanation

Question 36 of 36

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Baclofen is a muscle relaxant used to treat ( muscle spasticity, intention tremor, incontinence, dysarthria )

Explanation

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