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Medical Studies 2A > 4.6 Multiple Sclerosis > Flashcards

4.6 Multiple Sclerosis Flashcards

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USMLE® Step 1 flashcards
1
Q

Typical age of onset of MS is…

A

20-40 years old

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2
Q

What are the four disease courses of MS (names)?

A
  • Primary progressive
  • Secondary progressive
  • Relapsing remitting
  • Progressive relapsing
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3
Q

What is the most common MS disease course?

A

Relapsing remitting

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4
Q

Describe the progression of relapsing remitting MS

A
  • Sudden increase in disability
  • This gets better with time, leading to a period of remission, with disability still worse than pre-spike
  • Repeats
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5
Q

Describe the course of primary progressive MS

A

Linear increase in disease; no relapses

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6
Q

Describe secondary progressive MS

A

After a period of relapsing remitting MS, moves to linear progression

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7
Q

Describe progressive relapsing MS

A

Relapse spikes, separated by linear increases in disability.

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8
Q

Specifically, which parts of the peripheral nervous system are affected by MS?

A
  • None
  • CNS only
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9
Q

Describe the pathophysiology of MS, and link this to disease process. What causes worsening/remission of the disease?

A
  • Inflammation of CNS leads to release of inflammatory mediators, infiltration of CD8 T cells that kill oligodendrocytes, and B cells whose antibodies bind to myelin
  • Leads to demyelination and oligodendrocyte death
  • Remyelination (this is our “remission”, so in RR MS it goes back and forth here)
  • Eventually, the mechanisms of remyelination may become exhausted (nutrients, growth factors, progenitors etc.), leading to dysfunction, and neuronal death (permanent disability)
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10
Q

List some different symptoms of MS

A
  • Motor: spasms, weakness, balance/coordination issues
  • Fatigue
  • Vertigo, pins and needles, neuralgia
  • Bladder incontinence/constipation
  • Memory loss, depression, cognitive difficulties
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11
Q

If someone has an identical twin who has MS, their chance of developing the disease is…

A

50%

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12
Q

True or false: presence of another autoimmune disease increases MS risk

A

True :(

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13
Q

What are some environmental factors that can drive MS?

A
  • Smoking
  • Sunlight (more sun -> less MS)
  • Viral infection
  • Diet
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14
Q

What is the role of CD4 T Cells in the pathogenesis of MS?

A
  • Release inflammatory cytokines
  • Damaging the blood brain barrier and recruiting neutrophils, monocytes, and macrophages
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15
Q

Which cytokines to CD4 T cells release that are involved in the pathogenesis of MS?

A
  • IL-17 (neutrophil recruitment)
  • Interferon Gamma (activates CD8 cells and macrophages)
  • Granulocyte-macrophage colony stimulating factor (GM CSF)
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16
Q

What are the subsets of CD4 T cells important for the pathogenesis of MS?

A

Th1 and Th17

17
Q

What is the role of CD8 T cells in the pathogenesis of MS?

A

Cytotoxic to oligodendrocytes

18
Q

What is the role of B cells in the pathogenesis of MS?

A
  • Produce antibodies that bind to and destroy myelin
  • Present antigen to CD4 T Cells
19
Q

Where is it thought that autoreactive lymphocytes first gain access to the CNS?

A

Through the choroid plexus

20
Q

How does closeness to the equator link to risk of MS (this is very cool)?

A
  • Closer to the equator = more sunlight
  • More sunlight = lower risk of MS
  • Therefore, the closer we get to the equator, the lower the risk of MS
21
Q

What are some potential reasons why vitamin D might decrease the risk of MS?

A
  • Strengthens immune system
  • Influences cytokine expression
  • Increase production of immunosuppressive factors in CNS
22
Q

Which two viruses are most associated with the development of MS?

A
  • Epstein Barr virus
  • Herpes Human Virus 6
23
Q

Name 3 pharamacological treatments for MS prevention, and give a very brief outline of their mechanisms where applicable.

A
  • Beta interferon (alters T cell activity)
  • Glatiramer acetate (unknown)
  • Dimethyl fumarate (anti inflammatory)
24
Q

In terms of monoclonal antibodies for MS therapy: as we progress through first/second/third line therapy, what happens to safety and efficacy?

A
  • Safety decreases
  • Efficacy increases
25
Q

What factors allow the CNS to be an “immune privileged” site?

A
  • Blood brain barrier
  • Lack of lymphatic drainage
  • Limited expression of MHC molecules
26
Q

What is the role of T regulatory cells in MS?

A

Loss of regulation of autoreactive B cells and CD8 T cells -> CNS inflammation

27
Q

In terms of B cells, how might EBV worsen MS?

A
  • Latent memory of infection resides in memory B cells
  • Leads to larger autoimmune response within CNS

Medical Studies 2A (110 decks)

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