NCS > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

(89 cards)

Study These Flashcards
1
Q

What is Multiple Sclerosis?

A

An Autoimmune disease that is unpredictable, progressive, and usually attacks the CNS
- disrupts flow of info w/n brain and b/n brain and body (d/t demyelination of axons and loss of oligodendrocytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathology - What happens in the early acute stage of MS?

A
  • active myelin breakdown
  • plaques appear pink and swollen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathology - What happens in the subacute stage of MS?

A
  • plaques become paler in color “chalky”
  • abundant macrophages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathology - What happens in the chronic stage of MS?

A
  • little to no breakdown of myelin
  • gliosis w/associated volume loss
  • appear grey/translucent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is myelin or the axon affected early in MS disease process?

A

Myelin
- because axon can regenerate/recover but loses this with time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Demographics of MS patient diagnostic population

A
  • 3x Female > Male
  • 20-40 years old
  • predominately caucasian
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the potential causes of MS?

A
  • Abnormal immune system response causing inflammation
  • Environmental (areas away from equator, low Vit D, smoking, obesity in childhood/adolescence)
  • infection (EBV, HHV-6, Canine distemper, chlamydia pneumonia, measles)
  • Genetics or Hereditary? No, but increased risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the chance one twin will get MS if their identical twin has it?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to diagnosis MS?

A

McDonald Criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the McDonald Criteria?

A
  1. Dissemination in time: New attacks or relapses, or lesions have appeared on your MRI scans, at different points over time (need 2)
  2. Dissemination in space: Attacks have affected different parts of your brain or spinal cord, or scans show lesions in different areas (need 2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are new lesions over time confirmed?

A

CSF Oligoclonal bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How are lesions in space confirmed?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What areas of the CNS are more suseptible for MS lesions?

A
  • intracortical areas
  • periventricular areas
  • infratentorial
  • spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What qualifies as a clinical attack/relapse?

A

New/worsening neuro symptoms lasting >/= 24 hours, separated by >/= 30 days from prior attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Dissemination in Space

A

Lesions in >/= 2 distinct CNS areas (periventricular, cortical/juxtacortical, infratentorial, spinal cord)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Dissemination in Time

A

Evidence that disease occurred at different points in time
- New MRI lesion compared to previous MRI
- CSF- specific oligoclonal bands
- additional clinical attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is new w/the 2024 McDonald Criteria update?

A

Optic Nerve lesion for CNS location in dissemination in space
- commonly affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are signs and symptoms in MS? (7)

A
  • Attacks CNS (UMN signs)
  • spasticity
  • sensory changes (proprioception/vibration LE >UE), pain, t/n, parathesias (distally > proximally)
  • scissoring gait, ataxic gait
  • speech and swallowing difficulties
  • urinary incontinence
  • dizziness/vertigo (CN 8 involvement)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are unique MS signs and symptoms?

A
  • Lhermitte’s sign
  • Uhthoff’s phenomenon
  • Vision changes
  • Trigeminal neuralgia
  • Fatigue
  • Urinary incontinence
  • Cerebellar dysfunction: Charcot’s Triad
  • Cog changes: depression, pseudobulbar affect (can use MoCa)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are common vision S/S in MS?

A
  • optic neuritis
  • Marcus Gunn Pupil
  • Internuclear Opthalmoplegia
  • Scotoma
  • Oscillopsia
  • Optic disc pallor
  • Nystagmus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is Lhermitte’s sign?

A

When flex neck, “electric shock” or “lightening bolt” down back
(Unique to MS but can be seen with meningitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Uhthoff’s Phenomenon?

A

(sounds like Utah)
Heat intolerance - pseudo-exacerbation of symptoms if overheated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the presentation of optic neuritis?

A

Complaints of “ice-like” pain in eye
- can cause blindness over time
- CN2 affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Marcus Gunn Pupil

A

if pupillary light reflex affected d/t CN2 involvement –> reflex gets reversed
*paradoxical dilation of B pupils instead of constriction
(if marcus pulls out a gun, your eyes are going to go BIG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
What is internuclear opthalmoplegia?
Paralysis of eye muscles - Usually looking R, R eye uses CN 6 and L eye uses CN 3 at the same time. If affected, communication is lost so you have paralysis of eye movements (CN 3 is not going to adduct and CN 6 will go into nystagmus)
25
What is scotoma?
Blind spot in eye
26
What is Oscillopsia?
Jumping of vision
27
What is Trigeminal Neuralgia?
CN 5 involvement (3 branches, usually maxillary and mandibular are affected)
28
What % of people w/MS are affected by fatigue?
80% - can result in leaving jobs and inability to perform ADLs
29
What is Charcot's Triad?
Cerebellar can be affected w/MS (less common) 1. scanning speech 2. intention tremor 3. nystagmus ("S.I.N.")
30
In a patient with MS, what kind of incontinence is present?
MIXED - overflow - urge
31
What is pseudobulbar affect?
Abnormal emotion response - may laugh or cry for no appropriate reason
32
What are the 4 MS Types?
1. Relapse-Remitting (RR) 2. Primary Progressive 3. Secondary Progressive 4. Progressive Relapsing
33
What is Relapse-Remitting MS?
Short duration attacks w/full or partial recovery - may or may not leave lasting symptoms/deficits
34
What is the most common form of MS?
Relapse-Remitting (80%)
35
What is Primary Progressive MS?
Steady increase in disability w/o attacks/exacerbations
36
What is Secondary Progressive MS?
Initially Relapse-Remitting MS, then symptoms increase w/o periods of remission
37
What is Progressive Relapsing MS?
Steady increase in disability with superimposed attacks - Even between attacks it is worsening *eliminated from usage in 2013
38
What change to MS classifications was created in 2013?
Removed Progressive Relapsing MS and added Clinical Isolated Syndrome
39
What is Clinical Isolated Syndrome?
One isolated episode of MS symptoms First episode of inflammatory demyelination in the CNS - lasts at least 24 hrs - monofocal (ex. just optic neuritis) or multi focal (ex. optic neuritis & sensation change) - complete or partial recovery
40
How long can relapse phases last in RR MS?
1-3 months
41
What happens if you do not treat RR MS?
It transitions into secondary progressive MS
42
What is the "worst" type of MS?
Progressive Relapsing
43
What are the two types of Clinically Isolated syndrome?
1. Not active - no additional MRI activity (20% chance of developing MS) 2. Active - w/additional MRI activity >> Relapse-Remitting (60-80% change of developing MS w/n several years)
44
What group of individuals w/MS tend to have a progressive disease course?
> 65 years old
45
What are positive prognostic factors of MS? (7)
- younger age of disease onset - female (w/relapsing form) - complete recovery from first attack/relapse - lower relapse frequency early in disease - fewer symptoms involved at onset (mono-symptomatic onset) - lower MRI lesion burden at baseline (fewer T2 lesions, less atrophy) - early initiation of effect disease-modifying therapy (DMT)
46
If what structure is involved initially in MS, if that a positive prognostic sign?
Optic Nerve (CN 2)
46
What are negative prognostic factors of MS? (11)
- older age of onset (> 40 years or > 65 years) - male - motor, cerebellar, brainstem, or sphincter involvement at onset - high relapse rate in first 2-5 years; short interval to second relapse - incomplete recovery from first relapse - multifocal disease onset - high MRI lesion burden, early brain atrophy, elevated Df-enhancing lesions, or elevated biomarkers - Early transition to a progressive disease course - Early cognitive dysfunction or chronic depression - smoking/low Vit D - african american
47
What is the Kurtzke Expanded Disability Status Scale?
Disability Scale for MS (0-10) High score means more disability Looks at ambulation and 8 functional systems
48
What is a score of 0 on Kurtzke Expanded Disability Status Scale?
No disability
49
What is a score of 1.0-1.5 on Kurtzke Expanded Disability Status Scale?
No disability, abnormal signs on exam
50
What is a score of 2.0-2.5 on Kurtzke Expanded Disability Status Scale?
Minimal disability
51
What is a score of 3.0-3.5 on Kurtzke Expanded Disability Status Scale?
Moderate disability, but fully ambulatory
52
What is a score of 4-4.5 on Kurtzke Expanded Disability Status Scale?
Moderate disability, able to walk 300-500m
53
What is a score of 5.0-5.5 on Kurtzke Expanded Disability Status Scale?
Moderate disability, able to walk 100 - 200m
54
What is a score of 6-6.5 on Kurtzke Expanded Disability Status Scale?
Unilateral or Bilateral walking assistance
55
What is a score of 7.0-7.5 on Kurtzke Expanded Disability Status Scale?
Use of wheelchair
56
What is a score of 8.0-8.5 on Kurtzke Expanded Disability Status Scale?
Restricted to wheelchair
57
What is a score of 9.0-9.5 on Kurtzke Expanded Disability Status Scale?
Restricted to bed
58
What is a score of 10 on Kurtzke Expanded Disability Status Scale?
Death d/t MS
59
What does a score of 0-4.5 on Kurtzke Expanded Disability Status Scale indicate?
Able to walk independently
60
What does a score of 5-9.5 on Kurtzke Expanded Disability Status Scale indicate?
Impairments in ambulation
61
What 8 functional systems does the Kurtzke Expanded Disability Status Scale assess?
1. Pyramidal (motor) 2. Cerebellar 3. Brainstem 4. Sensory 5. Bowel and Bladder 6. Visual 7. Cerebral or Mental 8. Other
62
What are common forms of imaging used in MS?
1. MRI ( T1, T2, FLAIR) - detect plaques and atrophy 2. Evoked Potentials (checks how brain responds to sensory inputs 3. Lumbar puncture (CSF anaylsis) 4. CT scan (brain atrophy)
63
What is Dawson's finger sign?
Seen on MRI, classic of MS on imaging (in brain)
64
What is the benefit of using contrast in T1 MRI?
Bright areas will indicate ACTIVE inflammation and disease
65
What is benefit of T1 MRI?
dark lesions indicate areas of permanent axonal loss/chronic damage
66
What is the benefit of T2 MRI?
Can identify all lesions (old and new) to indicate total disease burden/lesion load
67
What is the benefit of FLAIR MRI?
- more sensitive Identify lesions near CSF to detect periventricular and cortical lesions
68
Medical Management of MS - Relapse
Medications; 3-5 day course IV - methylprednisolone - prednisone *corticosteroids - for anti-inflammatory
69
Medical Management of MS - Disease Modifying Treatment Plan
At time of diagnosis, treatment should continue INDEFINITELY unless any of the following occur: 1. Disease is not adequately controlled 2. Side effects are unbearable 3. Serious complications arise (ex. progressive multi-focal leukoencephalopathy) 4. Pt cannot adhere to treatment plan 5. A more suitable treatment option becomes available
69
What is a pseudo relapse?
Exacerbation of symptoms < 24 hours - can be d/t exercise, heat, UTI, fatigue
70
What is the benefit of disease modifying medications?
- decrease number and severity of relapses - less new inflammation - delayed progression of disability *immune system modifiers*
71
Recommended Outcome Measure PT for MS - Acute (6)
1. 12-Item MS Walking Score 2. 9-Hole Peg Test 3. BBS 4. MS Impact Scale (MSIS-29) 5. Timed 25 Foot Walk 6. TUG w/Cog and Manual Tasks
72
Recommended Outcome Measure PT for MS - IPR and OP (10)
*7-10 for outpatient only 1. 12-Item MS Walking Score 2. 9-Hole Peg Test 3. BBS 4. MS Impact Scale (MSIS-29) 5. Timed 25 Foot Walk 6. TUG w/Cog and Manual Tasks 7. Dizziness Handicap Inventory 8. MS Functional Composite 9. MS Quality of Life (MS QOL-54) 10. 6MWT
73
What is the 12-Item MS Walking Score?
Higher score = greater disability Subjective walking measure *more sensitive to changes in walking ability than EDSS or timed walking tests
74
What is the 12-Item MS Walking Score normative score for individual w/MS?
28.2 (healthy adults = 2.2)
75
What is the 9-Hole Peg Test?
Measure of finger dexterity Time taken to place all pegs in holes and return to container one-by-one
76
What is the 9-Hole Peg Test MCID?
20% difference
77
What score on 9-Hold Peg Test indicates severed hand dysfunction?
> 0.27 pegs per second (33.3s total) (Remember: 9 x 3 = 27)
78
What is the MDIC of MS Impact Scale?
8 pts (8 letters in MS Impact)
79
What is a clinically meaningful change in the Timed 25 Foot Walk Test in MS?
20-28% Change *Healthy adults take 4.4s *Individuals w/MS take ~50% longer
80
What is the Tug manual cut off scores?
>/= 14.5s
81
What is the Tug Cog cut off scores?
>/= 15 sec or difference of 4.5 or greater b/n TUG cog or TUG man
82
What is the MCID for MS Functional Composte?
20% Change *15% change may detect disease progression earlier but is less established
82
What tests does the MS Functional Composite Include? (3)
1. Timed 25 Foot Walk Test 2. 9-Hole Peg Test 3. Pace Auditory Serial Addition Test - 3 sec
83
What is the benefit of the MS Quality of Life (MS QOL-54)?
More sensitive to change in quality of life than other measures
84
What is the Cut Off Score of Dizziness Handicap Inventory for MS?
> 59 suggests increased risk of falls
85
What is the MCID of Dizziness Handicap Inventory for MS?
18 pts (9+9 = 18; 9 in Dizziness and 9 in Inventory)
NCS
flashcards
Decks in class (26)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions