Multiple Sclerosis and inflammatory CNS disease

Question 1

The F:M ratio for MS is?

Answer 1

3:1

Question 2

What are the clinical features of MS?

Answer 2

• Pyramidal dysfunction
• Optic neuritis
• Sensory symptoms
• Lr urinary tract dysfunction
• Cerebellar and brain stem features
• Cognitive impairement

Question 3

What are the features of pyramidal dysfunction?

Answer 3

• Increased tone
• spasticity
• weakness
• extensors of upper limbs
• flexors of lower limbs

Question 4

What is optic neuritis?

Answer 4

Painful visual loss
1 to 2 weeks
Most improve

Question 5

What is a clinical sign of optic neuritis?

Answer 5

RAPD

Question 6

What are the sensory symptoms of MS?

Answer 6

Pain
Paraesthesia
Dorsal column loss
- proprioception and vibration
Numbness 
Trigeminal neuralgia

Question 7

Describe cerebellar dysfunction in MS?

Answer 7

Dysarthria
Ataxia
Nystagmus
Intention tremor
Past pointing
Pendular reflexes
Dysdiodokineses

Question 8

What may be seen in brain stem dysfunction?

Answer 8

Diplopia

Facial Weakness

Question 9

What is the clinical presentation of internuclear ophthalmoplegia?

Answer 9

• Distortion of binocular vision
• Failure of adduction - diplopia
• Nystagmus in abducting eye
• Lag

Question 10

What part of the brainstem causes internuclear ophthalmoplegia

Answer 10

Medial longitudinal fasciculus

Question 11

Describe lower urinary tract dysfunction in MS?

Answer 11

Frequency
Nocturia
Urgency
Urge incontinence
Retention

Question 12

How can fatigue in MS be managed?

Answer 12

Amantadine
Modafinil if sleepy
Hyperbaric oxygen

Question 13

How is MS diagnosed clinically?

Answer 13

At least 2 episodes suggestive of demyelination

Dissemination in time and place

Alternative diagnosis excluded

Question 14

Which investigations are done for MS?

Answer 14

MRI
CSF
Neurophysiology
Blood tests

Question 15

List some differential diagnoses of MS

Answer 15

Vasculitis
Granulomatous disorder
Vascular disease
Structural lesion
Infection
Metabolic disorder

Question 16

What is found in CSF?

Answer 16

Oligoclonal bands in CSF

Question 17

What are the treatment options for spasticity?

Answer 17

Physiotherapy
Oral medication
- baclofen, tizanidine
Botulinum toxin
Intrathecal baclofen/phenol

Question 18

What are the options for sensory symptoms of MS?

Answer 18

Anti convulsant e.g. gabapentin

Anti depressant e.g.amitriptyline

Tens machine
Acupuncture
Lignocaine infusion

Question 19

Describe urinary dysfunction in MS?

Answer 19

• Increased tone at bladder neck
• Detruser hypersensitivity
• Detruser sphyncteric dyssenergia

Question 20

What are the treatment options for Lr urinary tract dysfunction in MS?

Answer 20

Bladder drill

Anti cholinergic e.g. oxybutynin

Desmopressin

Catheterisation

Question 21

What is the first line disease modifying therapy?

Answer 21

• Interferon beta- Avonex, rebif, Betaseron, extavia
• Glitiramer acetate
• Tecfedira, aubagio

Question 22

What is the second line disease modifying therapy?

Answer 22

• Monoclonal antibody- tysabri, ocrevus

- Fingolimod, cladrabine

Question 23

What is the third line disease modifying therapy?

Answer 23

Mitoxantrone, lemtrada

HSCT (stem cell transplantation)

Question 24

Interferons & glitiramer acetate are ________ agents (__,__)
They decrease relapse rate by / and decrease the severity of relapses by __%

Answer 24

Interferons & glitiramer acetate are injectable agents (sc,im)
They decrease relapse rate by 1/3 and decrease the severity of relapses by 50%

Question 25

Tecfidera is an ____ agent, it is the first line agent in __ __. It confers a __% reduction in relapse rate

Answer 25

Tecfidera is an oral agent, it is the first line agent in RR MS. It confers a 60% reduction in relapse rate

Question 26

Fingolimod and cadrabine are ____ agents, they confer a >__% reduction on relapse rate

Answer 26

Fingolimod and cadrabine are oral agents, they confer a >50% reduction on relapse rate

Question 27

Who is eligible for treatment with tysabri?

Answer 27

Patients with rapidly evolving severe relapsing remitting MS | Patients with high disease activity despite treatment with alpha interferon

Question 28

Trans-endotherlial migration of activated T-cells across ___ in EAE mediated by _______

Answer 28

Trans-endotherlial migration of activated T-cells across BBB in EAE mediated by integrins

Question 29

Describe the inflammatory cascade in MS?

Answer 29

1. immune cells pass through blood-brain barrier 2. immune cells may re-activate and produce cytokines 3. immune cells mount attack against myelin