Multiple sclerosis Flashcards
A 32-year-old woman presents with intermittent vision loss in her right eye and tingling in her legs. She recently moved from Florida to Canada. MRI shows multiple periventricular white matter lesions. Which of the following mechanisms underlies this disease?
(A) T-cell-mediated destruction of oligodendrocytes
(B) Autoantibody-mediated destruction of astrocytes
(C) Endothelial dysfunction leading to CNS ischemia
(D) Accumulation of β-amyloid plaques
A
A 25-year-old woman experiences episodes of weakness and sensory disturbances. She grew up in a northern climate with low sun exposure. Her vitamin D levels are low. Which of the following best describes the geographic pattern of her disease?
(A) More common in tropical regions
(B) More common in high-latitude regions
(C) More common in equatorial countries
(D) Uniform distribution across the world
B
A 30-year-old woman has recurrent episodes of limb weakness and fatigue. Her symptoms worsen in hot weather. She reports her mother had a similar condition. Which of the following is the most likely genetic predisposition?
(A) HLA-DR2
(B) HLA-B27
(C) HLA-DR4
(D) HLA-DQ2
A
A 29-year-old woman presents with acute, painful monocular vision loss. Fundoscopy is normal. MRI shows periventricular white matter lesions. What is the most likely diagnosis?
(A) Diabetic retinopathy
(B) Optic neuritis
(C) Retinal detachment
(D) Central retinal artery occlusion
B
A patient with MS experiences blurry vision and difficulty adducting her left eye when looking right. However, the right eye exhibits nystagmus. What is the most likely lesion?
(A) Oculomotor nerve (CN III)
(B) Medial longitudinal fasciculus (MLF)
(C) Optic nerve (CN II)
(D) Superior colliculus
B
A patient with MS complains of weakness and spasticity in his lower limbs. He describes an electric shock-like sensation down his spine when flexing his neck. What is this phenomenon called?
(A) Uhthoff phenomenon
(B) Lhermitte sign
(C) Horner syndrome
(D) Brown-Séquard syndrome
B
A 35-year-old woman with MS experiences worsening symptoms after exercising in warm weather. What is the name of this phenomenon?
(A) Lhermitte sign
(B) Uhthoff phenomenon
(C) Myasthenic crisis
(D) Brown-Séquard syndrome
B
A patient suspected of having MS undergoes a lumbar puncture. What is the most specific CSF finding?
(A) Decreased glucose
(B) Increased neutrophils
(C) Oligoclonal bands
(D) Presence of tau protein
C
A patient with MS has an MRI showing periventricular plaques and multiple white matter lesions disseminated in space and time. What is the cause of these plaques?
(A) Astrocyte hypertrophy
(B) Oligodendrocyte loss and gliosis
(C) Beta-amyloid accumulation
(D) Calcium deposition
B
Which imaging modality is considered the gold standard for diagnosing multiple sclerosis?
(A) CT scan
(B) MRI
(C) PET scan
(D) Ultrasound
B
A 33-year-old woman with MS presents with an acute flare of symptoms. What is the first-line treatment?
(A) IV steroids
(B) Plasmapheresis
(C) Beta-interferon
(D) Natalizumab
A
Which disease-modifying therapy is commonly used to slow MS progression?
(A) Acetylcholinesterase inhibitors
(B) β-Interferon
(C) Riluzole
(D) Carbidopa-levodopa
B
A patient with MS develops severe, treatment-resistant relapses. He is started on a monoclonal antibody that increases the risk of progressive multifocal leukoencephalopathy (PML). What drug was most likely given?
(A) Natalizumab
(B) Baclofen
(C) Glatiramer acetate
(D) Carbamazepine
A
A patient with MS develops spasticity in his lower limbs. What is the best treatment?
(A) Baclofen
(B) Riluzole
(C) Donepezil
(D) Levodopa
A
A 40-year-old woman with MS complains of urinary incontinence. Which treatment is most appropriate?
(A) Muscarinic antagonists
(B) Beta-blockers
(C) Loop diuretics
(D) Alpha-agonists
A
A patient with MS experiences neuropathic pain. What is the best pharmacologic treatment?
(A) Tricyclic antidepressants
(B) NSAIDs
(C) Acetaminophen
(D) Beta-blockers
A
A patient with MS has exacerbations and remissions of neurological symptoms. What term best describes this pattern?
(A) Chronic progressive
(B) Relapsing-remitting
(C) Secondary progressive
(D) Primary progressive
B
What histopathologic finding is characteristic of MS?
(A) Loss of oligodendrocytes
(B) Amyloid plaques
(C) Lewy bodies
(D) Neurofibrillary tangles
A
A 29-year-old woman with multiple sclerosis presents with new-onset right-sided weakness and worsening vision over the past 3 days. She has no fever or recent infections. MRI shows multiple periventricular plaques, some of which appear enhanced. What is the best initial treatment?
(A) Natalizumab
(B) IV methylprednisolone
(C) Plasmapheresis
(D) Beta-interferon
B
A 34-year-old woman with MS is started on a monoclonal antibody therapy. Three months later, she develops confusion, ataxia, and visual disturbances. MRI shows new non-enhancing white matter lesions with no mass effect. JC virus DNA is detected in the CSF. Which medication is most likely responsible?
(A) Fingolimod
(B) Natalizumab
(C) Glatiramer acetate
(D) Rituximab
B
A 37-year-old woman with MS complains of persistent fatigue despite adequate sleep. She denies depression or other medical conditions. Brain MRI shows multiple periventricular plaques. Which medication is most appropriate for her fatigue?
(A) Amantadine
(B) Gabapentin
(C) Baclofen
(D) Clonazepam
A
