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pathophysiology 4802 > MS (Final Exam) > Flashcards

MS (Final Exam) Flashcards

1
Q

this is an autoimmune disease of the central nervous system. it is characterized by
- chronic inflammation
- demyelination, gliosis (plaqures/scarring)
- neuronal loss
- can be relapsing or progressive

A

multiple sclerosis (MS)

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2
Q

what does the chronic inflammation in MS target

A

myelin sheath

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3
Q

how to gilal cells form plaques?

A

glial cells become astrocytes which proliferate and then harden and make plaques

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4
Q

true or false: axons are usually spared in MS

A

true

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5
Q

true or false: MS plaques typically develop at the same time in the same CNS locations

A

false - MS plaques typically develop at different times in different CNS locations

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6
Q

does MS usually affect younger or older adults

A

younger < 40

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7
Q

what are some risk factors for MS

A
  • genetic predisposition
  • vitamin D deficiency
  • Esptein-Barr virus (EBV) exposure after early childhood
  • cigarette smoking
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8
Q

which gene has the strongest susceptibility for MS

A

HLA-DRB1 gene

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9
Q

what are some other genes that may have susceptibility for MS

A
  • IL-7 receptor (CD127)
  • IL-2 receptor (CD25)
  • T cell costimulatory molecule LFA-3 (CD58)
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10
Q

do all genes lack sensitivity or specificity for MS?

A

both!

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11
Q

does specificity or sensitivity lead to false positives

A

sensitivity

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12
Q

do specificity or sensitivity lead to false negatives

A

specificity

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13
Q

how does the cellular immunity cause inflammation in MS

A
  • presence of perivenular T cells and macrophages (cuffing)
  • infiltrate the surrounding white matter
  • disrupt the blood brain barrier
  • distinct from vasculitis
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14
Q

how does the humeral immunity cause inflammation in MS

A
  • small numbers of B lymphocytes infiltrate the nervous system
  • presence myelin-specific autoantibodies on degenerating myelin sheaths
  • complement also activated
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15
Q

___________ is the pathological hallmark for MS

A

demyelination (damage to the myelin sheath)

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16
Q

these show up on MRI when someone has MS because 1/2 of the cells are regenerated and the other half are not. when there is a lack of myelin, we see grey. therefore these are called

A

shadow plaques

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17
Q

in MS, there is cerebral cortex involvement, which includes inflammation, demyelination and axonal loss. does the axonal loss start from distal to proximal or proximal to distal?

A

distal to proximal

18
Q

these resemble secondary lymphoid tissue
- aggregates of T and B lymphocytes
- proximity to plaques and perivascular spaces
- more common in progressive MS
- may contribute to subcortical demyelination and neurodegeneration

A

meningeal clusters

19
Q

what type of matter are meningeal clusters associated with

A

Pia matter

20
Q

________________ is always present during active demyelination or axonal injury and appears to differ between early and later stages

A

inflammation

21
Q

does this describe progressive or remission MS
- focal perivenular parenchymal infiltration of lymphocytes and monocytes
- BBB disruption and active demyelination

A

remission MS (RMS)

22
Q

does this describe progressive or remission MS
- more diffused with widespread microglial activation
- fewer acute perivascular infiltrates
- BBB not involved

A

progressive MS

23
Q

_________ occurs behind a partially repaired BBB

A

inflammation

24
Q

where are activated reactive t-cells present?

A

blood, CSF, MS lesions
myelin basic protein (MBP) antigen

25
Q

which t-cell populations are present in MS?

A

Th1, TNF-alpha and IGFN-gamma
- activation/maintenance of autoimmune responses
- direct injury to oligodendrocytes and myelin

Th17 and IL17

26
Q

where are B cells present?

A
  • myelin oligodendrocyte glycoprotein (MOG)
  • CSF
27
Q

these two factors are the main contributor to irreversible neurologic disability

A
  • cumulative axonal loss
  • neuronal loss
28
Q

about 7-% of axons are lost from the lateral corticospinal motor tracts in patients with advanced ___________

A

paraparesis (partial loss of control)

29
Q

what are some things that may cause axonal and neuronal death

A
  • glutamate-mediated excitotoxicity
  • oxidative jinjury
  • iron accumulation
  • mitochondrial failure
30
Q

explain how a nerve impulse is transmitted down an axon in a normal person vs someone with MS

A

normal: saltatory nerve impulse that jumps from one Node of Ranvier to the next. there are sodium channels at these nodes and is where depolarization occurs

MS: demyelination has occurs and there are now increased sodium channels distributed along the axon, which causes continuous propagation of the nerve action potential despite the absence of myelin

31
Q

is the clinical presentation of MS usually abrupt or inscidious?

A

could be either!

32
Q

true or false: can go from mild to severe symptoms very quickly

A

true

33
Q

list some symptoms of MS

A
  • sensory: parestesias (prickling), hypestesias, pain
  • optic neuritis: diminished visual acuity & color perception, periorbital pain
  • weakness of limbs: spasms, hyperreflexia, babinski sign
  • ataxia, vertigo
  • heat sensitivity
  • bladder dysfunction: detrusor hyperreflexia
  • constipation/bowel incontinence
  • cognitive dysfunction
34
Q

what are the three types of MS that exist

A
  • relapsing MS
  • primary progressive MS
  • secondary progressive MS
35
Q

this type of MS is characterized by discrete attacks of neurologic dysfunction that generally evolve over days-weeks. with initial attacks, there is usually complete recovery. however, as attacks continue, recovery may be less evident

A

relapsing MS (RMS)

36
Q

this type of MS always begins as RMS. At some point, however, the clinical course changes so that the patient experiences progressive deterioration in function unassociated with acute attacks. this produces a greater amount of fixed neurologic disability than RMS.

A

secondary progressive MS (SPMS)

37
Q

this type of MS, patents do not experience attacks, but rather a steady decline in function from disease onset.

A

primary progressive MS (PPMS)

38
Q

how is MS diagnosed

A

clinically defined MS is: two or more episodes of symptoms and tow or more signs with radiographic evidence (MRI); symptoms must last 24 hours and occur as separate episodes a month or more apart.

39
Q

what may indicate a favourable prognosis for MS

A
  • optic neuritis or sensory symptoms at onset
  • less than two relapses per year
  • minimal impairment after 5 years
40
Q

what may indicate a poor prognosis for MS

A
  • truncal ataxia (affects trunk/back muscles which causes a hesitation when trying to produce movement - looks drunk)
  • action tremor (different from Parkinsons)
  • progressive disease course

pathophysiology 4802 (16 decks)

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