Term
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Definition
| A demyelination disease of the CNS. |
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Term
| What is the most common age of onset for MS? |
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Definition
| 20-30yoa. There is later onset as well, but its not as common. |
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Term
| There are episodes of focal disorders in what areas? |
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Definition
| Optic nerves, spinal cord and brain. |
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Term
| What is the evidence for MS being caused by an environmental agent of some kind? |
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Definition
| It is found mostly in people who live their childhoods far from the equator. |
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Term
| What is the normal pattern of demyelination? |
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Definition
| There is no pattern. It's not bilateral, and the attacks are seemingly random. Demyelination may be followed by periods of remyelination that allow partial to full recovery from Sx for a while. |
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Term
| What is relapsing-remitting MS? |
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Definition
| Sx show up for a period of time, then disappear. The remyelination may be complete, allowing the pt to return to baseline after a relapse. The lapses vary in length and severity. |
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Term
| What relative age of onset is most commonly associated w/ relapsing/remitting MS? |
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Definition
| younger onset is more commonly associated w/ this type. |
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Term
| What is primary progressive MS? In what population is it most commonly seen? |
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Definition
| The disease gets slowly and steadily worse without remitting. Most common w/ older ages of onset. |
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Term
| what is secondary progressive MS? |
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Definition
| a relapsing-remitting course that later becomes steadily progressive. |
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Term
| What is progressive relapsing MS? |
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Definition
| A progressive course from the outset w/ obvious acute attacks along the way. |
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Term
| What are benign and malignan MS? |
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Definition
| Benign = minimal or no disability as a result of the disease. Malignant = rapid decline in function. |
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Term
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Definition
| It's determined on paraclinical evidence (lab tests; things pt doesn't complain about). History, neuro exam, clinical picture, MRI, CSF are all taken into account when making a Dx though. |
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Term
| What is the difference between definitive and probably MS? |
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Definition
| There is more evidence for, or more Sx of MS w/ definitive than w/ probable. |
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Term
| What is the best Dx test for MS? What does it look like? |
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Definition
| MRI - you can see little white plaques in the area corresponding to whatever dysfunction the pt is having. |
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Term
| What changes might be found in CSF? (5) |
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Definition
| 1. Mild increase in protein levels, 2. Increased IgG, 3. Oligoclonal IgG bands, 4. myelin based protein presence, 5. white blood cells. |
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Term
| what is myelin basic protein? |
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Definition
| It's protein found in the cell membrane of myelin from oligodendrocytes. |
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Term
| what are evoked potentials? |
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Definition
| A stimulus is applied somewhere in the periphery, and a response is elicited in the CNS. The time for the application to evoke a response is measured to tell how fast the impulse is traveling. |
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Term
| What is myelography, and how is it used in the Dx of MS? |
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Definition
| A picture is taken of the spinal cord to rule out other types of pathology. It's not used to Dx MS, but used to see if there's something else mimicking MS. |
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Term
| What are the major motor and sensory primary Signs and Sx of MS? (9) |
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Definition
| 1. Weakness/numbness. 2. Gait problems. 3. Reflex problems. 4. Intention tremor, dysmetria, incoordination, dysdiadochokinesia. 5. Lhermitt sign. 6. Fatigue. 7. vesitibular dysfunction. 8. dysarthria. 9. spasticity/clonus. |
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Term
| Where will you see weakness or numbness initially? |
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Definition
| Anywhere. It's typically noticed in one place first, though. ie: i leg feels like it won't support them or one arm feels weak. Not necessarily bilateral, and can be gross or fine motor. |
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Term
| What are the primary gait problems you will see w/ MS? (3) |
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Definition
| Ataxia (wide BOS), dragging one or both legs, spastic paraparesis. |
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Term
| What reflex deviations will you see primarily? |
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Definition
| DTR will be intact, but may be hyper-reactive. Positive babinski. The reflex changes are sometimes evident before the pt complains of weakness or sensory loss. |
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Term
| What is Lhermitte's test, and what causes a positive result? |
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Definition
| Passive flexion of the neck induces tingling down the shoulders and back and thighs. Probably due to stretch on the axons; demyelinated axons show incraesed sensitivity to stretch. |
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Term
| What is often the first Sx pts complain of? |
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Definition
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Term
| What are the common visual Sx? (3) |
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Definition
| 1. Optic Neuritis (rapid partial or total loss of vision in one eye) 2. Diplopia. 3. Nystagmus. |
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Term
| What are the common sensory impairments? (4) |
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Definition
| 1. parasthesias/numbness. 2. Impairment in pain, temp, deep touch. 3. vertigo (less common) 4. Pain (less common) |
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Term
| What are the bladder/bowel dysfunctions commonly seen? (5) |
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Definition
| 1. hesistancy, urgency, frequency. 2. Incontinence. 3. Urinary retention. 4. Impotence in men. 5. constipation. |
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Term
| MS pts often have altered emotional responses. What are they? |
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Definition
| It almost looks bipolar. Periods w/ depression, but also periods of euphoria. Also, emotionally labile - they have very little control over emotions, so cry and laugh easily w/ exaggerated responses. |
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Term
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Definition
| Inability to recognize certain sensory inputs. |
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Term
| What are the major categories of secondary impairments? (7) |
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Definition
| Psychosocial, musculoskeletal, renal, digestive, cardiovascular, respiratory, integumentary. |
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Term
| what causes secondary impairments? |
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Definition
| prolonged inactivity - not the disease process itself. |
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Term
| What are the musculoskeletal secondary impairments commonly encountered w/ MS? |
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Definition
| 1. progressive deformity due to inactivity/weakness. 2. spontaneous fractures due to osteoporosis. 3. heterotopic ossification (not as common) 4. Contractures (very common) |
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Term
| MS pts are at risk for kidney stones as a secondary impairment. Why? |
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Definition
| Because their inactivity leads to decalcification of the bones, which results in increased circulating calcium - which makes kidney stones. |
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Term
| what are the digestive alterations you may find? |
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Definition
| 1. decreased appetite/GI activity. 2. poor nutrition. 3. reduced healing. 4. constipation. |
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Term
| what are the four cardiovascular secondary impairments? |
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Definition
| 1. deconditioning. 2. increased HR response to effort. 3. orthostatic hypotension. 4. risk of thrombophlebitis. |
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Term
| what are the respiratory secondary impairments, and why do they occur? (3) |
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Definition
| 1. decrease in lung volume and vital capacity. 2. decreased respiratory endurance. 3. decreased efficacy of coughing/increased risk of infection. Due to weakness in respiratory muscles. |
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