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NR: (3) MS Questions With Complete Solutions
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NR: (3) MS Questions WithComplete Solutions
Multiple sclerosis - what is it? correct answer: - Progressive,
immune-mediated, inflammatory *demyelination of the CNS* =
UMN condition
- Disease course, symptoms and clinical presentations are
variable
Multiple sclerosis - pathophysiology correct answer: Not fully
understood, but...
1. Immune cells initiate inflammatory response --> attacks
*myelin, oligodendrocytes*, and *nerve fibers*
2. Results in *glial scars (plaques or lesions)* in brain,
brainstem, Cb, and spinal cord (white matter in early stages -->
gray matter lesions in advanced disease)
MS pathophysiology - lesions (plaques) have a predilection for...
(4) correct answer: 1. Optic nerve
2. Periventricular white matter
3. Spinal cord (CSTs, posterior columns)
4. Cerebellar peduncles
MS epidemiology - onset typically... correct answer: - Age 20s-
50s
- Women > men (RR and SP, not PP)
- Most commonly in Caucasians
,MS risk factors (3) correct answer: 1. Female, exposed to
passive smoking age <19
2. Genetic predisposition (primary relatives)
3. Latitudinal gradient (incidence varies based on location), may
have connection to vit D
MS diagnosis - initial symptoms are often... correct answer:
Visual changes (blurry vision, optic neuritis, etc.)
MS diagnosis - gold standard correct answer: - *MRI* to
identify lesions/plaques (however, no definitive diagnostic test)
- Appear as a hyper-intense (bright) spot
MS diagnosis - criteria (3) correct answer: "Dissemination in
*space* and *time*"
1. Space = lesions visible on T2 MRI in at least TWO separate
areas of the CNS
2. Time = lesions occurred at different points in time
3. Also, rule out all other diagnoses (infections or inflammatory
disorders, genetic, vitamin deficiencies, other demyelinating
disorders etc.)
MS diagnosis - McDonald Criteria correct answer: - Purpose: to
improve Sn, Sp, and timeliness of testing
- MRI lesions AND lumbar puncture --> *CSF oligoclonal
bands* (independent predictor of risk of a second attack when
controlling for other variable)
MS exacerbations correct answer: - "Relapses" or "attacks"
- Repeated *inflammatory processes* resulting in new
neurological symptom(s) or worsening of old symptom
, - Lasts *at least 24 hours* and NOT due to another cause (i.e.
otherwise "pseudoexacerbation")
- Associated factors = infections, disease of major organ
systems, stress
MS - medical management (3) correct answer: - No cure
- Medications for... (2 main classes)
1. *Disease modifying therapies*
2. *Symptom management*
3. Also, relapse management
MS - medications for relapses (4) correct answer: - Do NOT
modify disease course; instead suppress the immune /
inflammatory response in attempt to shorten the duration of the
relapse
- Includes:
1. High dose corticosteroids - IV 3-5 days, oral 1-3 weeks
2. ACTH (adrenocorticotropic hormone)
3. Intravenous Immunoglobulin (IVIG)
4. Plasmapheresis
MS - disease modifying therapies (4 pros, 3 cons) correct
answer: PROS
1. Slow natural course of MS
2. Reduce frequency/severity of clinical attacks in RRMS (by
~28-68%)
3. Reduce development of new areas of damage in brain and SC
4. Slow accumulation of disability
CONS
1. Expensive
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