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Nurse Practitioner:
doi: 10.1097/01.NPR.0000428853.48550.b1
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Multiple sclerosis: Managing patients in primary care

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INSTRUCTIONS Multiple sclerosis: Managing patients in primary care

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Multiple sclerosis: Managing patients in primary care

General Purpose: The purpose of this learning activity is to provide information about the diagnosis, clinical course, and current treatment of MS. Learning Objectives: After reading this article and taking this test, you should be able to: 1. Describe the pathophysiology and symptomatology of MS. 2. Discuss diagnosis and management of the patient with MS.

1. In North America, MS has higher prevalence rates in the

a. northern states.

b. southern states.

c. gulf coast.

d. western states.

2. The diagnosis of MS is first made three times more frequently in

a. Blacks than Whites.

b. women than men.

c. Hispanics than those of Middle Eastern descent.

d. persons over age 50 than younger persons.

3. Which IMD is contraindicated for the MS patient with severe hepatic impairment?

a. fingolimod

b. mitoxantrone

c. teriflunomide

d. interferon beta-1a

4. One of the two distinct pathology processes associated with MS is

a. infection.

b. myelin sheath regeneration.

c. immunodeficiency.

d. inflammation.

5. What is the result of the disintegration of denuded axons?

a. inflammation

b. demyelination

c. atrophy

d. release of HLA

6. What pathology is often observed on MRI before a diagnosis of MS is made?

a. axonal destruction

b. neural scarring

c. lesions in the gray matter

d. atrophy of the white matter

7. Approximately 80% of MS patients are diagnosed with which type of MS?

a. secondary progressive

b. relapsing-remitting

c. progressive-relapsing

d. primary progressive

8. In the absence of a single test for MS, what clues help the clinician make the diagnosis?

a. age, ethnicity, and gender related to neurologic complaints

b. bilateral vision loss

c. peripheral neuropathy

d. tinnitus and extrapyramidal symptoms

9. Which statement about Lhermitte sign is accurate?

a. It is a brief, shock-like sensation down the spine.

b. It occurs with neck extension.

c. It is diagnostic for MS.

d. It correlates with inflammation of the brain stem.

10. Which test is least likely to help with diagnosing MS?

a. CSF analysis

b. MRI of the brain

c. complete blood cell count

d. evoked potential testing

11. Which diagnostic test has made the most dramatic impact on diagnosing MS?

a. computed tomography

b. positron emission tomography

c. MRI

d. antinuclear antibodies

12. Which statement is true about symptoms of MS?

a. All MS patients initially present with sensory disturbances.

b. Symptoms of MS include motor, sensory, cognitive, and emotional manifestations.

c. The most common secondary symptom is blurred vision or diplopia.

d. Lhermitte sign indicates proprioceptive impairment.

13. Which form of MS has no FDA-approved IMDs for treatment?

a. secondary progressive

b. relapsing-remitting

c. progressive-relapsing

d. primary progressive

14. IMDs should be initiated as soon as possible because

a. pathogenicity is influenced by immunomodulation early in the disease.

b. if IMDs are started early, there is a higher incidence of permanent remission.

c. younger patients respond more quickly to IMDs.

d. IMDs double the time to disability.

15. Clinicians must be aware that one of the adverse outcomes of corticosteroid therapy is

a. risk of infection.

b. dehydration.

c. hypotension.

d. hypersomnolence.

16. Which complementary therapy for MS has been shown to be beneficial for symptom management and quality of life?

a. ginseng

b. garlic

c. cannabis

d. exercise

17. The NP should explain to women of childbearing age that

a. MS can have an adverse effect on pregnancy outcomes.

b. MS decreases fertility.

c. the number of MS relapses often decreases during pregnancy.

d. anesthesia used during labor and delivery must be carefully tailored for MS patients.

18. Which statement is true about acute relapses?

a. They are defined as local neurologic disturbances lasting 12 to 24 hours.

b. They are often triggered by environmental circumstances.

c. They are treated with glucocorticoids.

d. Uhthoff syndrome is a common type of relapse.

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