Pregnancy and MS: myths and truths
NMOtion
When bad things happen to good people: side effects
Rehab makes the world go round
My Real Insight (MRI)
100
Name the MS therapeutic agent that requires special elimination prior to attempted pregnancy, AND the method of elimination
What is teriflunomide (Aubagio). Elimination is accomplished by cholestyramine or activated charcoal 11-day course.
100
Most sensitive and specific assay for anti-AQP 4 antibody
What is cell-based assays? Serologic diagnosis of NMO: a multicenter comparison of aquaporin-4-IgG assays. Waters PJ, McKeon A, Leite MI, Rajasekharan S, Lennon VA, Villalobos A, Palace J, Mandrekar JN, Vincent A, Bar-Or A, Pittock SJ. Neurology. 2012 Feb 28;78(9):665-71
100
This type of flu vaccine is not safe in patients taking immunosuppressive medications.
What is flu mist? Williamson, E. M., Chahin, S., & Berger, J. R. (2016). Vaccines in Multiple Sclerosis. Current neurology and neuroscience reports, 16(4), 1-8.
100
At which EDSS score does a patient require intermittent or unilateral constant assistance (cane, crutch, brace) required to walk about 100 meters with or without resting?
What is 6.0?
100
Ovoid lesions perpendicular to the ventricles on MRI
What are Dawson’s fingers?
200
Short-term IV steroids are sometimes used for treating a relapse during pregnancy. Which type of oral/IV steroid should be avoided during pregnancy?
What is dexamethasone?
200
What do circles and NMO have in common?
CIRCLES: The Collaborative International Research in Clinical and Longitudinal Experience for Neuromyelitis Optica (NMO) Studies (CIRCLES). Largest (5000 subjects), longest (5-yr), most comprehensive attempt to understand NMO. Now enrolling in Seattle (but you get to keep your patients)
200
Patients taking metoprolol or citalopram may require special monitoring when starting this disease modifying therapy.
What is fingolimod (Gilenya)? Laroni, A., Brogi, D., Morra, V. B., Guidi, L., Pozzilli, C., Comi, G.,... & Mancardi, G. L. (2014). Safety of the first dose of fingolimod for multiple sclerosis: results of an open-label clinical trial. BMC neurology, 14(1), 1.
200
Which nerve and its innervated muscles are assisted with the Bioness or Walk aide e- stim device? 
What is peroneal nerve?
200
Every 3-6 months for serum JCV positive patients and > than 18 months on natalizumab?
What is the timing of PML surveillance brain protocol?
300
Is epidural anesthesia contraindicated among women with MS?
No
300
CSF testing for antibodies to aquaporin-4 (NMO IgG) offers no additional value beyond that gained by serum testing: true or false?
True. Neurol Neuroimmunol Neuroinflamm. 2016 Apr 20;3(3):e231
300
This medication may improve gastrointestinal tolerability of dimethyl fumarate (Tecfidera).
What is montelukast (Singulair)? Tornatore, C., Walsh, J., Mann, M., Li, J., & Von Hehn, C. (2015). Effect of Montelukast on Gastrointestinal Tolerability in Patients With Relapsing Forms of Multiple Sclerosis Receiving Delayed-Release Dimethyl Fumarate: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study (MITIGATE)(P1. 127). Neurology, 84(14 Supplement), P1-127
300
Which muscles of the plantar flexor group are plantarflexors of the foot and also knee flexors? 
What are Gastrocnemius and Plantaris. NOT Soleus
300
3D sagittal T2-weighted Flair images and 2D axial DWI images
What is the MRI brain protocol recommended for PML surveillance?
400
Women with MS considering assisted reproductive techniques should be counseled to avoid which type of ART?
Avoid GnRH agonists (as opposed to antagonists)
400
Name the outlier: a) eculizumab b) IL-6R blocker c) TNF-alpha blocker d) serial PLEX
What is TNF-alpha blocker. All the other ones are in various stage clinical trials for treatment of NMO.
400
This medication can cause cardiac dysfunction and monitoring with echocardiograms is recommended even after discontinuation of treatment.
What is mitoxantrone (Novantrone)? Marriott, J. J., Miyasaki, J. M., Gronseth, G., & O'Connor, P. W. (2010). Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 74(18), 1463-1470.
400
Which quadriceps muscle is also a hip flexor as it crosses the hip joint?
What is rectus femoris?
400
About 1%/year
What is the annual rate of brain atrophy among MS patients? (contrast to 0.2% normal)
500
Name RF for post-partum MS relapse and estimate the risk of MS relapse
RF: higher relapse rate and disability prior to pregnancy, lack of prior DMT use, and relapse during pregnancy Relapse risk: 28% in pivotal PRIMS study.
500
In addition to optic neuritis and acute myelitis, name at least one other symptom considered “core clinical feature” for NMO, and part of the core clinical features in the diagnostic criteria
3. Area postema syndrome 4. Acute brainstem syndrome 5. Symptomatic narcolepsy or diencephalic clinical syndrome + typical MRI 6. Symptomatic cerebral syndrome + typical MRI Neurology. 2015 Jul 14;85(2):177-89.
500
This disease modifying medication can be associated with PML even in patients that are JCV antibody negative
What is natalizumab (Tysabri)? Brosseau, M. S. G., Stobbe, G., & Wundes, A. (2016). Natalizumab-related PML 2 weeks after negative anti-JCV antibody assay. Neurology, 10-1212.
500
What are common causes of knee hyper extension with gait in an MS patient? 
What are weakness of quads and plantar flexors to stabilize the knee at heel strike and push off as well as spasticity of the plantar flexors.
500
Peripheral hyperintensity and central hypointensity on DWI are classic for this lesion.
What is the appearance of PML on diffusion-weighted imaging?
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