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27 Cards in this Set
- Front
- Back
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this is the bodys immune system breaking down the protective sheath covering the nerves, it disrupts the communication between the brain and body that is irreversible
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MS
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how many events and how long spaced before the diagnosis of MS
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>2 events
>30 days apart |
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What are some causes of MS
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unknown
autoimmune affecting white matter in the brain enviromental - toxins, viral, vitamin d deficiency genetics |
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what does MS affect
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brain
spinal cord and optic nerve |
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what is the age of onset for MS
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30-50
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which sex has a higher prevalence
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female 2X
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what are some risk factors for MS
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age 20-40
caucasian family history cold climate viral infections having other autoimmune diseases |
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What is device syndrome
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severe relapses involving spinal cord and optic nerve, called neuromyelitis optica
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this is a mono phasic illness, distinct entity from MS but is related, post-viral dysfunction of the CNS - in pediatric group
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acute disseminated encephalomyelitis
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What clinical features are suggestive of MS
1. relapsing - remitting course 2. continued progression 3. Uvietitis 4. Optic Neuritis 5. Encephalopathy 6. Diurinal fatigue pattern 7. Extrapyramidal symptoms 8. Apraxia 9. Electric shock with flexion of neck 10. Urinary retention 11. Agnosia 12. Seizures |
onset 15-20 years
relapsing-remitting optic neuritis electric shock with neck flexion urinary retention diurnal fatigue pattern - worse with activity and heat |
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how are the neuro/sensory symptoms of MS
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numbness
tingling Lhermittes Sign - electric shock tremor unsteady gait fatigue dizziness numbness changes locations a lot sensory symptoms can occur at any level of the body |
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what are urinary symptoms of MS
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urgency
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what are eye symptoms of MS
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partial or complete loss
double vision blurred vision |
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what are differentials for MS
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fibromyalgia
Myelopathy secondary to cervical spondylosis sleep disorder Sjogen B12 def - parasthesia Lymphoma Sarcoidosis Guillian-Barre Syndrome Mitochonrial Disease ALS |
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what is your neurological exam for a patient with MS
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Sensation - which can be difficult
Vibration Proprioception Abdominal reflex Babinski Chaddocks Sign - big toe extension Lhermittes Sign Fundo, EOM, nystagmus |
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what changes in sensation occur with MS
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ascending numbness in feet
bilateral hand numbness- useless hand syndrome hemiparesthesia general heat intolerance dysesthesia in one of |
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what is reduced in the sensory exam
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Vibration
proprioreception sterogenesis |
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what are the diagnostic tests for MS
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none specific - need to rule out other causes
CBC CMP TSH B12 ANA ESR RPR - lyme Anti-NMO antibody CSF MRI - white matter change |
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what are the treatment options for MS
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manage the exacerbations, symptom management and modification of the disease course
Steriods and Plasma Exchange IVIG |
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what is symptoms management for MS
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PT and OT - stretching, ADL retraining
Muscle Relaxants - Baclofen (increase leg weakness), Tizandine (drowsy and dry mouth) Flexeril, soma, valium Amatadine - for parkinsons, reduce fatigue depression meds bladder and bowel meds if sx |
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what are some lifestyle modifications needed in MS
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rest
exercise temperature control balanced diet stress relief alternative treatements |
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what is the prognosis in 15 years of MS
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will need assistance devices
lesions do not correlate with disease |
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what are favorable prognostic indicators for MS
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early onset
female sex optic neuritis as presenting episode sensory impairment at presenting episode acute onset little residual disability after exacerbation long period between exacerbations |
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what are unfavorable prognostic indicators for MS
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later onset
progressive course since onset male sex frequent exacerbations poor recovery after involvement of motor function or cerebellar |
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what does Beta Interferon do for MS and the SE
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liver damage
slow down progression of disease |
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what does Glatiramer (Copaxone) do for MS
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block immune systems attack on the myelin
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what does Fingolimod (Gilenya) do for treatment of MS
what are the SE and what vaccine is needed with it |
trape immune cells in lymph nodes, reducing attacks, and short term disability
varicella vaccine SE: HTN and blurred vision, monitor HR |
