Multiple Sclerosis - Presentation, Diagnosis & Management

Matthew Coulson
Quiz by Matthew Coulson, updated more than 1 year ago
Matthew Coulson
Created by Matthew Coulson almost 2 years ago
11
1

Description

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

Resource summary

Question 1

Question
Multiple Sclerosis is a condition whereby the [blank_start]myelin sheathes[blank_end] of [blank_start]CNS tracts[blank_end] are broken down. Lesions also appear in the [blank_start]CNS[blank_end], and these are referred to as [blank_start]plaques[blank_end].
Answer
  • myelin sheathes
  • axons
  • cell bodies
  • dendrites
  • CNS tracts
  • PNS neurons
  • plaques
  • cysts
  • aggregates
  • CNS
  • PNS

Question 2

Question
Multiple Sclerosis affects [blank_start]only CNS tracts[blank_end]
Answer
  • only CNS tracts
  • only PNS neurons
  • both CNS tracts and PNS neurons

Question 3

Question
Multiple Sclerosis is more prevalent in ...
Answer
  • Females
  • Males

Question 4

Question
Multiple Sclerosis tends to initially present ...
Answer
  • in the teens
  • between 30 and 40 years of age
  • in those over 50 years of age

Question 5

Question
To be specific, Multiple Sclerosis is the loss of the cells that produce myelin in the CNS, known as [blank_start]oligodendrocytes[blank_end]
Answer
  • oligodendrocytes

Question 6

Question
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? [blank_start]Corticospinal tract[blank_end]
Answer
  • Corticospinal tract

Question 7

Question
The pyramidal dysfunction associated with Multiple Sclerosis tends to cause spasticity/weakness/etc to the [blank_start]extensors[blank_end] of the upper limbs and the [blank_start]flexors[blank_end] of the lower limbs
Answer
  • extensors
  • flexors
  • flexors
  • extensors

Question 8

Question
Which visual condition is present in 50% of MS sufferers, and is the first sign of MS in 20% of sufferers? [blank_start]Optic neuritis[blank_end]
Answer
  • Optic neuritis

Question 9

Question
How does Optic Neuritis present? (2 right answers)
Answer
  • Acute onset pain in eye upon eye movement
  • Central blurriness/visual loss
  • Peripheral blurriness/visual loss
  • Red eye
  • Floaters in visual field

Question 10

Question
In most cases, optic neuritis is a self-resolving condition given a few months.
Answer
  • True
  • False

Question 11

Question
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 [blank_start]Trigeminal Neuralgia[blank_end].
Answer
  • Trigeminal Neuralgia

Question 12

Question
Trigeminal Neuralgia only tends to affect 2-4% of MS patients. These patients are typically treated using an anticonvulsant called
Answer
  • Sodium Valproate
  • Carbamazepine
  • Lamotrigine
  • Acetazolamide
  • Diazepam

Question 13

Question
What are the main two cerebellar manifestations of Multiple Sclerosis?
Answer
  • Ataxia
  • Tremor
  • Slurred speech
  • Dizziness
  • Headaches

Question 14

Question
Multiple Sclerosis can cause CNVI palsy. How would this present?
Answer
  • Inability to abduct the eyes, causing diplopia
  • Inability to gaze downwards, causing diplopia
  • Negative pupillary light reflex

Question 15

Question
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 [blank_start]abducting[blank_end] eye and is called [blank_start]Internuclear Ophthalmoplegia[blank_end]
Answer
  • abducting
  • adducting
  • Internuclear Ophthalmoplegia
  • Chronic Progressive Ophthalmoplegia
  • Internal Ophthalmoplegia

Question 16

Question
70-80% of Multiple Sclerosis sufferers have lower urinary tract problems. The most common are [blank_start]increased[blank_end] frequency and [blank_start]urge[blank_end] incontinence.
Answer
  • increased
  • decreased
  • urge
  • stress
  • overflow

Question 17

Question
Amantadine is a drug commonly prescribed to Multiple Sclerosis patients suffering from
Answer
  • Fatigue
  • Speech Impairment
  • Sexual Issues
  • Emotional Issues (e.g. Depression)

Question 18

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

Question 19

Question
Name the criteria typically used to diagnose multiple sclerosis. The [blank_start]McDonald[blank_end] Criteria
Answer
  • McDonald

Question 20

Question
Which imaging study should be conducted in order to diagnose Multiple Sclerosis?
Answer
  • MRI
  • CT
  • X-ray

Question 21

Question
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 [blank_start]IgG[blank_end] on electrophoresis, which are inflammation markers found in 75–85% of people with Multiple Sclerosis.
Answer
  • IgG
  • IgA
  • IgE

Question 22

Question
In the most basic sense, acute exacerbations of multiple sclerosis are treated by the following: Mild: [blank_start]Symptomatic treatment[blank_end] Moderate: [blank_start]Oral steroids[blank_end] Severe: Admit & give [blank_start]IV Steroids[blank_end]
Answer
  • Symptomatic treatment
  • Watchful waiting
  • No treatment
  • Oral steroids
  • Oral anticonvulsants
  • Oral antidepressants
  • IV Steroids
  • IV Anticonvulsants
  • IV Antiepileptics

Question 23

Question
Baclofen is a medication used to treat ... in MS patients
Answer
  • Spasticity
  • Sensory Symptoms
  • Lower Urinary Tract Dysfunction
  • Fatigue

Question 24

Question
Sensory symptoms caused by MS (pain, paraesthesia, numbness, etc) can be treated by the following: Anti convulsant, e.g. [blank_start]Gabapentin[blank_end] Anti depressant, e.g. [blank_start]Amitriptyline[blank_end]
Answer
  • Gabapentin
  • Amitriptyline
  • Amantadine

Question 25

Question
The lower urinary tract dysfunction caused by multiple sclerosis can be treated by a Vasopressin Analogue called ...
Answer
  • Desmopressin
  • Terlipressin
  • Carbopressin

Question 26

Question
Despite this, the most common long term management of lower urinary tract dysfunction in multiple sclerosis patients is...
Answer
  • Pelvic floor muscle training
  • Catheterisation
  • Anticholinergics e.g. Oxybutynin

Question 27

Question
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. [blank_start]Interferon Beta[blank_end]: Balances expression of pro- and anti-inflammatory agents in the brain & reduces number of inflammatory cells crossing the blood brain barrier. [blank_start]Glitiramer Acetate[blank_end]: Shifts the population of T cells from pro-inflammatory Th1 T-cells to regulatory Th2 T-cells that suppress the inflammatory response.
Answer
  • Interferon Beta
  • Glitiramer Acetate
  • Interferon Gamma

Question 28

Question
How are Interferon Beta & Glitiramer Acetate (Copaxone) administered in MS patients?
Answer
  • Subcutaneous/Intramuscular
  • Intravenous
  • Sublingual
  • Oral

Question 29

Question
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?
Answer
  • Fingolimod
  • Mitoxantrone

Question 30

Question
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
Answer
  • 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

Question 31

Question
The presence of which Human Leukocyte Antigen predisposes to multiple sclerosis?
Answer
  • HLA B27
  • HLA DR2
  • HLA D45
  • HLA BR7

Question 32

Question
Which type of multiple sclerosis is the most common?
Answer
  • Relapsing Remitting
  • Primary Progressive
  • Secondary Progressive
  • Progressive Relapsing

Question 33

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

Question 34

Question
Charcot's triad is indicative of Multiple Sclerosis. This consists of ...
Answer
  • Dysarthria
  • Nystagmus
  • Intention Tremor
  • Chorea
  • Myoclonus
  • Lhermitte's Sign
  • Incontinence

Question 35

Question
[blank_start]Lhermitte's[blank_end] sign = Electric shock-like jerk which potentiates down the spine and radiates into the limbs when an individual bends their neck forwards.
Answer
  • Lhermitte's

Question 36

Question
Baclofen is a muscle relaxant used to treat [blank_start]muscle spasticity[blank_end]
Answer
  • muscle spasticity
  • intention tremor
  • incontinence
  • dysarthria
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