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.
- In North America, MS has higher prevalence rates in the
- northern states.
- southern states.
- gulf coast.
- western states.
- The diagnosis of MS is first made three times more frequently in
- Blacks than Whites.
- women than men.
- Hispanics than those of Middle Eastern descent.
- persons over age 50 than younger persons.
- Which IMD is contraindicated for the MS patient with severe hepatic impairment?
- interferon beta-1a
- One of the two distinct pathology processes associated with MS is
- myelin sheath regeneration.
- What is the result of the disintegration of denuded axons?
- release of HLA
- What pathology is often observed on MRI before a diagnosis of MS is made?
- axonal destruction
- neural scarring
- lesions in the gray matter
- atrophy of the white matter
- Approximately 80% of MS patients are diagnosed with which type of MS?
- secondary progressive
- primary progressive
- In the absence of a single test for MS, what clues help the clinician make the diagnosis?
- age, ethnicity, and gender related to neurologic complaints
- bilateral vision loss
- peripheral neuropathy
- tinnitus and extrapyramidal symptoms
- Which statement about Lhermitte sign is accurate?
- It is a brief, shock-like sensation down the spine.
- It occurs with neck extension.
- It is diagnostic for MS.
- It correlates with inflammation of the brain stem.
- Which test is least likely to help with diagnosing MS?
- CSF analysis
- MRI of the brain
- complete blood cell count
- evoked potential testing
- Which diagnostic test has made the most dramatic impact on diagnosing MS?
- computed tomography
- positron emission tomography
- antinuclear antibodies
- Which statement is true about symptoms of MS?
- All MS patients initially present with sensory disturbances.
- Symptoms of MS include motor, sensory, cognitive, and emotional manifestations.
- The most common secondary symptom is blurred vision or diplopia.
- Lhermitte sign indicates proprioceptive impairment.
- Which form of MS has no FDA-approved IMDs for treatment?
- secondary progressive
- primary progressive
- IMDs should be initiated as soon as possible because
- pathogenicity is influenced by immunomodulation early in the disease.
- if IMDs are started early, there is a higher incidence of permanent remission.
- younger patients respond more quickly to IMDs.
- IMDs double the time to disability.
- Clinicians must be aware that one of the adverse outcomes of corticosteroid therapy is
- risk of infection.
- Which complementary therapy for MS has been shown to be beneficial for symptom management and quality of life?
- The NP should explain to women of childbearing age that
- MS can have an adverse effect on pregnancy outcomes.
- MS decreases fertility.
- the number of MS relapses often decreases during pregnancy.
- anesthesia used during labor and delivery must be carefully tailored for MS patients.
- Which statement is true about acute relapses?
- They are defined as local neurologic disturbances lasting 12 to 24 hours.
- They are often triggered by environmental circumstances.
- They are treated with glucocorticoids.
- Uhthoff syndrome is a common type of relapse.