Final Exam (MS) Flashcards
Which of the following statements is/are TRUE?
I. Hallmark of MS are plaques or sclerosed areas in CNS
II. MS is most commonly seen in elderly patients
III. There is an increased risk the closer you live to equator
A. I only
B. I & II
C. III only
D. I, II, & III
A. I only
MS is is a disease of young people and most commonly seen between ages 15-45. There is an increased risk of developing MS the FURTHER you live from the equator (i.e. people in Antarctica would have a HIGHEST risk of developing MS)
Which of the following regarding MS is/are FALSE?
A. Risk factors for developing MS include smoking, infection, and urbanization
B. There is a genetic component in developing MS
C. Epstein-Barr virus has not been shown to be associated with MS
D. Optic neuritis is a common first presenting symptom
E. B & C
C. The greatest link between infection and development of MS is seen with the Epstein-Barr virus (EBV). EBV antibiotic titers are higher in MS patients and increase over time vs controls.
All of the following are characteristic of the pathophysiology of MS, EXCEPT:
A. Axonal damage B. Remyelination C. Demyelination D. Inflammation of the CNS E. None of the above
E. None of the above.
MS is characterized by inflammation of the CNS. In MS, myelin sheath surrounding axons of nerve cells is progressively stripped off (DEMYELINATION). Associated with INFLAMMATORY RESPONSE and production of inflammatory cytokines. Infiltration of the CNS by T and B lymphocytes, macrophages, antibodies, and complement causes axonal damage.
Myelin sheath is able to repair itself to some degree (REMYELINIZATION) early in the disease preserving axonal function. However…
Every attack produces damage and damage eventually becomes irreversible with severity correlating to disability.
Demyelination, inflammatory response, and axonal damage produce LESIONS or PLAQUES which can be seen on MRI
T/F:
Formation of lesions can produce any type of neurological symptom (ex. vision issues, parasthesias, or muscle weakness)?
True
Loss of myelin sheath inhibits normal conduction of impulses resulting in progressive loss of functions. (6) typical deficits include?
- muscle weakness
- fatigue
- slurred speech
- blurred vision
- diminished coordination
- sensory disturbances
Which of the following statements is/are TRUE:
I. MS is an autoimmune disease
II. Activation of T-cells in the periphery occurs before the inflammatory response in the CNS
III. Th1 and Th17 proinflammatory cells help the body fight off MS attack
A. I only
B. I & II
C. III only
D. I, II, & III
B. I & II
The order of an attack:
- Activation of T-helper cells in periphery
- Th1 and Th17 attach to BBB, secrete an enzyme that produces an opening in BBB allowing them and other proinflammatory cells to cross into CNS
- Once inside CNS, T-cells produce other proinflammatory cytokines such as: interleukins, TNF, interferon gamma
- Interferon gamma creates even more openings in BBB allowing entry and production of: B-cells, complement, macrophages, and antibodies
- Inflammatory response causes axonal damage
MS is an autoimmune disease in which the body attacks:
A. Myeline sheath
B. Oligodendrocytes
C. All of the above
C. All of the above
What are the (2) most common primary Sx of MS?
- Visual complains (optic neuritis)
2. Parasthesias (tingling, burning of skin typically in extremities)
Explain “lesions separated by space and time” with regards to MS diagnosis.
Diagnosis of MS requires demonstration of “lesions separated by space and time”
The occurrence of at least two separate distinct episodes of neurological disturbances occurring 30 days apart, each lasting at least 24 hours, reflecting different sites of damage (lesions) seen in the CNS that cannot be explained by another mechanism
Neurological disturbances = primary S/Sx such as: pain, weakness, uncoordinated movement, cognitive changes, fatigue, bowel/bladder dysfunction, tremor, speech difficulty
Diagnosis with the McDonald criteria involve which of the following:
A. MRI B. CSF C. Visual evoked potential (VEP) D. A & B E. All of the above
E. All of the above
MRI is the most definite assessment showing lesions in brain. Lesions are seen in 95% of patients with clinically definite MS (CDMS) and 65-85% of patients with possible MS or clinically isolated syndrome (CIS). Patients with CIS and 3+ lesions on MRI have 90% chance of developing CDMS within 15 years.
Examining CSF (not blood) for elevated levels of IgG and oligoclonal bands (bands of immunoglobulins). ≥5 oligoclonal bands are present in 90-95% of all patients with CDMS. Analysis of CSF is usually reserved for patients with abnormal presentation or with possible MS in which a more definitive diagnosis is needed.
Visual evoked potential test is an objective tool testing nerve conduction helpful in determining areas of demyelination that are clinically not seen.
Which of the following statements is FALSE:
I. Patient can be diagnosed with CDMS after the first attack with evidence of 3+ lesions on MRI
II. With occurrence of a 2nd “attack” patient now has clinically definite MS (CDMS)
III. No disease progression occurs in between attacks for patients with Relapsing-Remitting MS (RRMS)
A. I only
B. I & II
C. III only
D. I, II, & III
A. I only
The first “attack” a patient gets in which they experience any of the primary Sx is called clinically isolated syndrome (CIS). Remember, diagnosis of MS requires evidence of demyelination in TWO distinct areas of the CNS (lesions separated by space and time). A patient with a single attack of demyelination + 3 lesions on MRI has a very good chance of going on to develop CDMS, but does not have CDMS yet.
All of the following statements are true, EXCEPT:
A. The majority of MS patients have RRMS
B. Progressive forms of MS, disease progression and damage is occurring at all times
C. Within 10-20 yrs, up to 50% of RRMS patients will convert to secondary-progressive MS (SPMS)
D. Patients with primary progressive MS (PPMS) have the worst prognosis
E. Patients with PPMS have clear “attacks” and “remission”
E. Patients diagnosed with PPMS have progressive disease right from the start. Patients do NOT have “attacks” and “remissions.” Disease progression occurring at all times.
Which of the following statements about Radiologically Isolated Syndrome (RIS) is/are TRUE:
A. Is a form of CDMS B. No lesions on MRI, but Sx present C. Lesions on MRI, but no Sx present D. A & B E. B &C
C. RIS is NOT form of CDMS. It is characterized by lesions on MRI, but NO Sx of CIS/MS
This rare type of MS starts with the progressive form of the disease right from the start, but there appears to be clear relapses with or without full recovery. Progression continues in-between disease relapses even when patient looks like they’re in remission. What is this rare type of MS called?
Progressive-relapsing MS (PRMS)
What is the expanded disability status scale (EDSS)?
EDSS is an objective tool used to measure progression of MS disease. Typically used in clinical trials to show efficacy of drug.
