Chapter 11: Associated Topics - Ms, Osteoporosis, Burns

Front 1

Who gets MS?

Back 1

White
20-50 yo
RICH (higher socioeconomic class)
FEMALES
with positive family histories

Front 2

Which pattern of MS?
most common

Back 2

Relapse-Remitting

*long periods of stability with a return to baseline or mild disability after each exacerbation

Front 3

Which pattern of MS?
When the most common pattern of MS coverts to steady deterioration.

Back 3

Secondary Progressive

Front 4

Which pattern of MS?
Mild symptoms, early exacerbations, and complete remissions with minimal or no disability.

Back 4

Benign

Front 5

Which pattern of MS?
Deterioration with relapses, with increasing degree of relapses and residual impairment

Back 5

Progressive-Relapsing

Front 6

Which pattern of MS?
Affects males and females EQUALLY

Back 6

Primary Progressive

*Can progress rapidly to death in weeks to months. It is more common in the older population.

Front 7

Which pattern of MS?
Insidious onset with steady progression, few remissions & increasing disability.

Back 7

Primary Progressive

*Can progress rapidly to death in weeks to months. It is more common in the older population, and male to female ratio is 1:1.

Front 8

Which pattern of MS?
Rapid and severe

Back 8

MALIGNANT

Front 9

MS: Good or bad prognostic factor?
age of onset <35 years

Back 9

GOOD

Front 10

MS: Good or bad prognostic factor?
MONOsymptomatic

Back 10

GOOD

Front 11

MS: Good or bad prognostic factor?
Opitic neuritis (sensory) at onset

Back 11

GOOD

Front 12

MS: Good or bad prognostic factor?
Ataxia & tremor (motor) at onset

Back 12

BAD

Front 13

MS: Good or bad prognostic factor?
Male gender

Back 13

BAD

Front 14

What are the top 3 most prevalent symptoms in MS?

Back 14

1. Bowel/bladder dysfxn
2. Fatigue (central in nature)
3. Pain

Front 15

What is the name for the diagnostic criteria for MS?

Back 15

McDonald Criteria

*Based on a combination of clinical & objective measures

Front 16

What does one look for in CSF evaluation of a patient with MS?

Back 16

- Increased protein
- Increasd IgG (greatest sensitivity, 85%)
- Increasd WBC

Front 17

What will you see in 75% of MS patients when Visual Evoked Potentials (VEP) are performed?

Back 17

P100 latency slowing due to plaques

Front 18

What will you see frequently in MS patients when Somatosensory Evoked Potentials (SSEPs) are performed?

Back 18

- Prolonged latency of TIBIAL nerve evoked potential
- Absence of TIBIAL nerve evoked potential

Front 19

What is characteristic of ACTIVE MS lesions on MRI?

Back 19

Only active lesions enhance with GADOLINIUM contrast.

Front 20

What MRI findings point to a diagnosis of MS?

Back 20

T2 hyperintensities in white matter of brain, optic nerves, spinal cord

*also in periventricular white matter of corpus callosum
*MRI findings in 85% of cases

Front 21

How do you treat ACUTE attacks of MS?

Back 21

500–1000 mg/day IV Methyprednisolone x3–5 days with or without an oral taper

*cerebellar or sensory symptoms are least responsive to this therapy

Front 22

How do you treat MS in terms of long-term management?

Back 22

- Interferon-beta 1a, 1b
- Glatiramer acetate (Copaxone)
- Natalizuamab (Tysabri)
- Immunosuppresants (cyclosporine, methotrexate, cytotoxin, IVIg)

Front 23

What is the drug of choice for managing MS-related spasticity?

Back 23

Baclofen

Front 24

What are some agents you can use to treat the fatigue associated with MS?

Back 24

- modafanil
- amantadine
- fluoxetine
- methylphenidate (Ritalin)

Front 25

Optic neuritis is a finding in what % of MS patients?

Back 25

25%

*central scotoma is a common visual field
defect

Front 26

Internuclear Ophthalmoplegia in MS is due to demyelination of what structure?

Back 26

Medial longitudinal fasciculus (MLF)

*Paresis of the medial rectus muscle results in inability to ADDUCT on lateral gaze, convergence remains intact however.

Front 27

What is the suicide rate in those with MS compared to normal controls?

Back 27

MS = 7.5x higher

Front 28

What % of MS patients will require ambulatory assistance within 10 years of diagnosis?

Back 28

33%

Front 29

Difference between osteoMALACIA & osteoPOROSIS?

Back 29

Osteoporosis = decreased DENSITY, normal ratio of mineral:organic components

Osteomalacia = decreased ratio of mineral:organic components, normal density

Front 30

Promotes bone RESORPTION (into blood stream) or bone FORMATION?
Estrogen & testosterone

Back 30

FORMATION

*osteoBLASTS ("B" for build)

Front 31

Promotes bone RESORPTION (into blood stream) or bone FORMATION?
Glucocorticoids

Back 31

RESORPTION

*decreasd Calcium absorption in the gut

Front 32

Promotes bone RESORPTION (into blood stream) or bone FORMATION?
PARATHYROID HORMONE

Back 32

RESORPTION

*PTH is released when Ca level in blood is too low or blood is acidic

Front 33

Promotes bone RESORPTION (into blood stream) or bone FORMATION?
Normal level of THYROID HORMONE

Back 33

FORMATION

Front 34

Promotes bone RESORPTION (into blood stream) or bone FORMATION?
Excess THYROID HORMONE

Back 34

RESORPTION

Front 35

Promotes bone RESORPTION (into blood stream) or bone FORMATION?
Acidosis

Back 35

RESORPTION

Front 36

Who is at greatest risk for osteoporosis?

Back 36

- Thin (BMI <20)
- Inactive
- White or Asian
- Females
- Smoke/drink alcohol/drink coffee
- Positive family hx
- Hx of fx as adult
- Menopausal (loss of ovarian fxn)

Front 37

What effect does PTH have on the kidneys?

Back 37

Increases phosphate excretion
Increases CALCIUM REABSORPTION
Also promotes activation of vitamin D

*Overall RAISES amount of Calcium in blood

Front 38

What effect does PTH have on the intestines?

Back 38

Vitamin D activation via the kidneys causes increasd absorption of calcium

Front 39

What does Calcitonin do?

Back 39

INCREASES FORMATION OF BONE (therefore decreasing Calcium level in blood)

*Stimulates osteoBLASTS, inhibits osteoclasts

Front 40

What is the most common cause of SECONDARY osteoporosis?

Back 40

Steroid use

*inhibits osteoBLASTS

Front 41

T-score or Z-score?
The number of standard deviations (SD) away from the mean of a reference population.

Osteoporotic value?

Back 41

T-score

-1 to -2.5
*normal is 1 to -1
*this is what DIAGNOSIS is based on, not on Z-score

Front 42

T-score or Z-score?
The number of SDs the patient’s bone density is compared to adults of the same age and gender.

Osteoporotic value?

Back 42

Z-score

*No osteoporotic value, T-score is used for diagnosis NOT Z-score

Front 43

DXA scan measurements at the lumbar spine are useful for what purpose?

Back 43

monitoring response to therapy

Front 44

DXA scan measurements at the proximal femur are useful for what purpose?

Back 44

predicting hip fxs

Front 45

How much Ca & Vit D are recommended for patients that are at highest risk for osteoporosis?

Back 45

1000-1500mg/day of Calcium
400-800 IU/day of Vit D

Front 46

What is Forteo (teriparatide)?

Back 46

Injectable form of human PTH, used to treat osteoporosis

Front 47

What treatmtent can you give postmenopausal osteoporotic women that are unable to take estrogen d/t side effects or risks of breast/uterine cancer?

Back 47

SERM: Raloxifene (Evista)

*Selecetive estrogen receptor modulator

Front 48

Where are the three most common sites of fracture in osteoporosis?

Back 48

1. Vertebrae (lower thoracic/upper lumbar anterior wedge)
2. Hip
3. Wrist (Colles)

*Wrist is most common fx in females >75 yo

Front 49

What is the Parkland Formula for fluid resuscitation in burns?

Back 49

4 cc/kg body weight divided by % BSA

- half given in first 8 hours
- remaining over next 16 hours

Front 50

A scar will grow and then contract until maturity in what time period?

Back 50

1-1.5 years

Front 51

What is the most common site of HO joint involvement in the context of BURNS?

Back 51

ELBOW