MS & demyelination flashcards
16 high-yield MRCP Part 1 cards from the Intellect Medicos Neurology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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What is the investigation of choice for suspected multiple sclerosis?
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MRI brain and spinal cord (with contrast).
Why? MRI shows plaques spread in space and time (e.g. periventricular "Dawson's fingers", juxtacortical, brainstem, cord).
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What is the treatment of an acute MS relapse affecting function?
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Oral methylprednisolone 0.5 g daily for 5 days. IV methylprednisolone 1 g daily for 3-5 days if oral fails, is not tolerated or admission is needed.
Why? Steroids speed recovery from a relapse but do not change long-term disability.
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What is the target of natalizumab in MS, and its most feared complication?
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Alpha-4 integrin (α4β1), blocking lymphocyte entry into the CNS. Risk: progressive multifocal leukoencephalopathy (JC virus).
Why? PML risk rises with JC virus antibody positivity, longer treatment and prior immunosuppression.
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What is the mechanism of fingolimod, and which adverse effect needs monitoring with the first dose?
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Sphingosine-1-phosphate receptor modulator (traps lymphocytes in lymph nodes). First-dose bradycardia or heart block.
Why? S1P receptors on cardiac cells mediate slowing of heart rate, so heart rate and ECG are monitored after the first dose.
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Which disease-modifying drug is licensed for primary progressive MS, and what is its target?
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Ocrelizumab, an anti-CD20 monoclonal antibody.
Why? B-cell depletion reduces inflammatory activity. It is used in both relapsing and primary progressive MS.
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What is the first-line drug for spasticity in MS?
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Oral baclofen.
Why? Baclofen is a GABA-B agonist that reduces muscle tone. Gabapentin is second-line (or combined with baclofen). Tizanidine, diazepam and dantrolene are later options.
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MS patient with urinary incontinence: post-void residual on ultrasound is 150 mL. What is the management?
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Intermittent self-catheterisation.
Why? A residual over 100 mL means incomplete emptying. Anticholinergics are used only if the residual is not significant.
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A 28-year-old woman cannot adduct her left eye on looking to the right; the right eye shows abducting nystagmus. Convergence is normal. Where is the lesion, and what is the most likely cause?
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Left medial longitudinal fasciculus (left internuclear ophthalmoplegia); multiple sclerosis.
Why? The MLF links the CN VI nucleus to the opposite CN III nucleus. A lesion stops the eye on the same side from adducting. Convergence uses a separate pathway, so it is spared.
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Which antibody characterises neuromyelitis optica, and what spinal MRI finding is typical?
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Anti-aquaporin-4 (AQP4). Longitudinally extensive transverse myelitis spanning 3 or more vertebral segments.
Why? NMO targets the optic nerves and cord more severely than MS. Area postrema involvement causes intractable hiccups and vomiting.
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Which MS disease-modifying drugs are generally considered compatible with pregnancy?
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Interferon-beta and glatiramer acetate (natalizumab may be continued in selected high-activity cases).
Why? Many oral DMTs (e.g. teriflunomide, fingolimod) are teratogenic and must be stopped before conception.
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Which oral MS drug commonly causes flushing and GI upset, and needs regular lymphocyte counts?
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Dimethyl fumarate.
Why? Prolonged severe lymphopenia raises the risk of PML. It is used for moderately active relapsing MS.
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Alemtuzumab in MS: what is its target, and which delayed complication needs long-term monitoring?
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CD52; secondary autoimmune disease, especially thyroid disease (also ITP and nephropathy).
Why? It depletes lymphocytes. Autoimmunity can appear years after the last dose, so monitoring continues for several years.
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Once other causes are excluded and non-drug measures have not helped, name one drug NICE suggests for MS-related fatigue.
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Amantadine (modafinil or an SSRI are the other options).
Why? Exclude anaemia, thyroid disease, depression, sleep problems and infection first. Non-drug measures (CBT, exercise, mindfulness) come first.
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NMO relapse prevention: eculizumab targets ______; satralizumab targets the interleukin-6 receptor.
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complement C5
Why? These monoclonal antibodies are used for AQP4-antibody-positive NMO spectrum disorder. Inebilizumab (anti-CD19) is another option.
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NMO relapse prevention: eculizumab targets complement C5; satralizumab targets the ______.
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interleukin-6 receptor
Why? These monoclonal antibodies are used for AQP4-antibody-positive NMO spectrum disorder. Inebilizumab (anti-CD19) is another option.
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What is the first-line treatment of acute transverse myelitis?
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High-dose IV methylprednisolone (1 g daily for 3-5 days); plasma exchange if the response is poor.
Why? MRI of the spine first excludes cord compression. Long lesions (3 or more segments) suggest NMO; short patchy ones suggest MS.