Multiple Sclerosis Immune Response Quiz
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Questions and Answers

Which of the following cells are primarily involved in the immune response in Multiple Sclerosis (MS)?

  • Neurons
  • Myocytes
  • Myelin-reactive T cells (correct)
  • Erythrocytes

    • What is the pathologic hallmark of Multiple Sclerosis (MS)? Which of the following is a key feature of acute MS lesions?

  • Hypercellularity with macrophages and hypertrophic astrocytes (correct)
  • Axonal regeneration
  • Decreased infiltration by lymphocytes and monocytes
  • Myelination of affected nerve fibers

    • In Multiple Sclerosis (MS), the immune system targets which part of the neuron?

  • Axon
  • Myelin sheath (correct)
  • Dendrite
  • Synaptic cleft

    • Which of the following immune molecules is involved in the recruitment of T helper (TH1) cells to the site of injury in MS?

    <p>Osteopontin (OPN) (B)</p> Signup and view all the answers

    The dysregulation of the immune system in MS leads to damage primarily through:

    <p>Chronic inflammation and demyelination (B)</p> Signup and view all the answers

    Which of the following therapies is used in the treatment of Multiple Sclerosis (MS)?

    <p>All of the above (D)</p> Signup and view all the answers

    In Multiple Sclerosis (MS), what role does the blood-brain barrier play in the pathophysiology of the disease?

    <p>It is disrupted, allowing immune cells to infiltrate the CNS (B)</p> Signup and view all the answers

    Which of the following immune responses is implicated in the progression of MS lesions?

    <p>Activation of macrophages and microglia (B)</p> Signup and view all the answers

    Which of the following is a known genetic risk factor for Multiple Sclerosis (MS)?

    <p>A polymorphism in the IL-23 receptor gene (B)</p> Signup and view all the answers

    Which cells are predominantly involved in the inflammatory process in MS lesions?

    <p>Macrophages and lymphocytes (B)</p> Signup and view all the answers

    Which histologic feature is commonly observed in acute MS lesions?

    <p>Hypercellularity with macrophages and hypertrophic astrocytes (B)</p> Signup and view all the answers

    Which of the following changes is NOT typically seen in acute MS lesions?

    <p>Increased blood-brain barrier integrity (C)</p> Signup and view all the answers

    What type of lesions are most commonly observed in the pathology of MS?

    <p>Circumscribed demyelinating lesions in white and gray matter (B)</p> Signup and view all the answers

    Which of the following is a prominent feature of MS lesions during acute stages?

    <p>Activation of microglia and macrophages around blood vessels (C)</p> Signup and view all the answers

    Which of the following is true regarding the genetic risk for MS?

    <p>Monozygotic twins have a higher concordance rate for MS than dizygotic twins. (A)</p> Signup and view all the answers

    Which of the following is a known environmental risk factor for MS?

    <p>Vitamin D deficiency (B)</p> Signup and view all the answers

    What is the latitudinal gradient associated with the prevalence of MS?

    <p>Increased prevalence of MS further from the equator (B)</p> Signup and view all the answers

    What genetic variant is most commonly associated with an increased risk of developing MS?

    <p>HLA DRB1*1501 (A)</p> Signup and view all the answers

    What is the primary association between Epstein-Barr virus (EBV) and MS?

    <p>MS is rare in individuals seronegative for EBV. (C)</p> Signup and view all the answers

    Which of the following is a common presentation of multiple sclerosis (MS)?

    <p>Optic neuritis (B)</p> Signup and view all the answers

    What is the typical manifestation of optic neuritis in multiple sclerosis?

    <p>Unilateral visual loss with pain on eye movement (B)</p> Signup and view all the answers

    Which of the following is a classic sign associated with optic neuritis in multiple sclerosis?

    <p>Relative afferent pupillary defect (RAPD) (B)</p> Signup and view all the answers

    The Lhermitte phenomenon is associated with which of the following? A) Transverse myelitis B) Brainstem syndromes C) Optic neuritis D) Multiple sclerosis

    <p>Multiple sclerosis (D)</p> Signup and view all the answers

    What is the primary clinical manifestation of transverse myelitis in multiple sclerosis?

    <p>Sensory loss and weakness in the legs (B)</p> Signup and view all the answers

    In optic neuritis, which of the following is typically observed as a chronic sign?

    <p>Optic disc pallor (C)</p> Signup and view all the answers

    What does the presence of a Relative Afferent Pupillary Defect (RAPD) in optic neuritis suggest?

    <p>Inflammation of the optic nerve (B)</p> Signup and view all the answers

    What is the usual duration of pain in optic neuritis?

    <p>Two weeks (B)</p> Signup and view all the answers

    Which of the following is NOT a common feature of brainstem syndromes in multiple sclerosis?

    <p>Tinnitus (D)</p> Signup and view all the answers

    What does the presence of a Relative Afferent Pupillary Defect (RAPD) in optic neuritis suggest?

    <p>A sign of optic nerve inflammation (B)</p> Signup and view all the answers

    Which of the following is an acute sign of optic neuritis seen during an eye examination?

    <p>Optic disc swelling (C)</p> Signup and view all the answers

    What is typically observed as a chronic sign of optic neuritis?

    <p>Optic disc pallor (B)</p> Signup and view all the answers

    Which of the following is a typical symptom of brainstem or cerebellar syndrome?

    <p>Facial palsy (B)</p> Signup and view all the answers

    Nystagmus, often seen in brainstem syndromes, involves dysfunction of which part of the brain?

    <p>Brainstem pathways controlling eye movements (C)</p> Signup and view all the answers

    Which of the following signs is associated with one-and-a-half syndrome?

    <p>Paralysis of one eye's movement and nystagmus in the other (B)</p> Signup and view all the answers

    What is the underlying cause of Lhermitte's symptom in spinal cord lesions?

    <p>Demyelination of spinal cord pathways (B)</p> Signup and view all the answers

    Which of the following is a sign of upper motor neuron (UMN) lesions, such as those seen in spinal cord lesions?

    <p>Spastic paraplegia (C)</p> Signup and view all the answers

    What does increased tone and clonus in upper motor neuron lesions reflect?

    <p>Increased reflex activity due to damage to the corticospinal tract (C)</p> Signup and view all the answers

    Which of the following is typically seen in cerebellar syndrome?

    <p>Ataxia (lack of coordination) (C)</p> Signup and view all the answers

    Which of the following symptoms is NOT commonly associated with spinal cord lesions?

    <p>Difficulty breathing (C)</p> Signup and view all the answers

    The brisk reflexes seen in upper motor neuron lesions are a result of what?

    <p>Increased spinal reflex excitability due to loss of inhibition (A)</p> Signup and view all the answers

    The upgoing plantar response (Babinski sign) is indicative of damage to which pathway?

    <p>Corticospinal tract (upper motor neuron pathway) (A)</p> Signup and view all the answers

    Brown-Sequard syndrome is typically caused by a lesion affecting which part of the spinal cord?

    <p>One half of the spinal cord (B)</p> Signup and view all the answers

    Which of the following signs is commonly seen in Brown-Sequard syndrome?

    <p>Loss of motor function on the same side of the body (D)</p> Signup and view all the answers

    Which of the following sensory deficits is observed in the opposite side of the body in Brown-Sequard syndrome?

    <p>Loss of pain and temperature sensation (C)</p> Signup and view all the answers

    Which of the following is not a common symptom of cerebral hemisphere involvement in MS?

    <p>Lhermitte's phenomenon (D)</p> Signup and view all the answers

    Cognitive impairment in MS often results from which of the following?

    <p>Gray matter damage in the cerebral hemispheres (A)</p> Signup and view all the answers

    What is the hallmark characteristic of relapsing-remitting MS (RRMS)?

    <p>Clearly defined relapses with recovery between episodes (B)</p> Signup and view all the answers

    Secondary progressive MS (SPMS) is typically preceded by which subtype of MS?

    <p>Relapsing-remitting MS (C)</p> Signup and view all the answers

    What is the primary difference between primary progressive MS (PPMS) and secondary progressive MS (SPMS)?

    <p>SPMS begins with relapses, while PPMS progresses from onset. (B)</p> Signup and view all the answers

    Which classification of MS is described as "one episode suggestive of MS, but not meeting diagnostic criteria"?

    <p>Clinically isolated syndrome (CIS) (C)</p> Signup and view all the answers

    Why is social history important in the management of MS?

    <p>To identify home adaptations needed for disability (C)</p> Signup and view all the answers

    Which of the following is not a differential diagnosis for MS?

    <p>Huntington's disease (D)</p> Signup and view all the answers

    Which infection is commonly considered in the differential diagnosis of MS?

    <p>Syphilis (C)</p> Signup and view all the answers

    Neuromyelitis optica (NMO) differs from MS primarily because:

    <p>It has a specific IgG biomarker. (C)</p> Signup and view all the answers

    Which investigation is most diagnostic for MS?

    <p>MRI of the brain and spinal cord with gadolinium (A)</p> Signup and view all the answers

    CSF findings in MS include all of the following except:

    <p>Presence of viral DNA (D)</p> Signup and view all the answers

    Which of the following is a confirmatory test for vitamin deficiency as a potential mimic of MS?

    <p>Serum B12 and folate (B)</p> Signup and view all the answers

    Visual evoked potentials in MS are:

    <p>Delayed but non-diagnostic (B)</p> Signup and view all the answers

    What is the role of very long-chain fatty acids (VLCFA) in MS investigations?

    <p>To rule out adrenoleukodystrophy (B)</p> Signup and view all the answers

    What is the hallmark MRI finding in multiple sclerosis?

    <p>Hyperintense lesions on T2-weighted imaging (B)</p> Signup and view all the answers

    Which MRI feature indicates active inflammation in MS?

    <p>Gadolinium enhancement (A)</p> Signup and view all the answers

    What does CSF analysis typically show in multiple sclerosis?

    <p>Oligoclonal IgG bands (B)</p> Signup and view all the answers

    What does delayed visual evoked potentials (VEP) suggest in MS?

    <p>Slowed conduction due to demyelination (C)</p> Signup and view all the answers

    What is the significance of gadolinium enhancement in MRI for MS?

    <p>It highlights active inflammation. (C)</p> Signup and view all the answers

    What are the McDonald criteria used for?

    <p>To confirm the diagnosis of MS based on clinical and MRI findings (B)</p> Signup and view all the answers

    Which of the following demonstrates dissemination in space according to the McDonald criteria?

    <p>≥1 T2 lesion in at least 2 of 4 CNS regions (A)</p> Signup and view all the answers

    Which of the following is NOT one of the CNS regions used to assess dissemination in space?

    <p>Temporal lobe (C)</p> Signup and view all the answers

    Which of the following demonstrates dissemination in time according to the McDonald criteria?

    <p>Presence of new Gadolinium-enhancing and non-enhancing lesions simultaneously (A)</p> Signup and view all the answers

    How can dissemination in time be demonstrated in MS according to the McDonald criteria?

    <p>New T2 and/or Gadolinium-enhancing lesion(s) compared to a baseline MRI (A)</p> Signup and view all the answers

    What role do unmatched oligoclonal bands in the CSF play in the McDonald criteria?

    <p>They confirm dissemination in time. (B)</p> Signup and view all the answers

    What is required to demonstrate dissemination in space for MS diagnosis using the McDonald criteria?

    <p>At least one lesion in two or more specified CNS regions (B)</p> Signup and view all the answers

    What is the first-line treatment for an acute exacerbation of MS?

    <p>IV Methylprednisolone (B)</p> Signup and view all the answers

    In cases where MS exacerbations are refractory to steroids, which treatment is recommended?

    <p>Plasmapheresis (B)</p> Signup and view all the answers

    Which of the following medications is used to manage spasticity in MS patients?

    <p>Baclofen (C)</p> Signup and view all the answers

    A patient with MS reports chronic neuropathic pain. Which medication is appropriate?

    <p>Amitriptyline (A)</p> Signup and view all the answers

    Which of the following is a pharmacological option for managing MS-related fatigue?

    <p>Modafinil (A)</p> Signup and view all the answers

    Which drug is used to manage bladder dysfunction in MS patients?

    <p>Oxybutynin (B)</p> Signup and view all the answers

    Which medication is suitable for managing MS-related sexual dysfunction?

    <p>Sildenafil (B)</p> Signup and view all the answers

    Depression in MS patients can be treated with which medication?

    <p>Venlafaxine (A)</p> Signup and view all the answers

    What is the role of physiotherapy in MS management?

    <p>Managing muscle spasticity and improving mobility (C)</p> Signup and view all the answers

    What is the only Disease-Modifying Therapy (DMT) currently licensed for Primary Progressive MS (PPMS)?

    <p>Ocrelizumab (Ocrevus) (C)</p> Signup and view all the answers

    Which of the following is a first-line Disease-Modifying Therapy for Relapsing-Remitting MS (RRMS)?

    <p>Interferon-beta (B)</p> Signup and view all the answers

    Which medication is used to manage MS-related fatigue?

    <p>Amantadine (A)</p> Signup and view all the answers

    What is the mechanism of action for Glatiramer acetate in MS?

    <p>Suppresses autoreactive T-cells (B)</p> Signup and view all the answers

    Which of the following is a benefit of Disease-Modifying Therapies (DMTs) for Relapsing-Remitting Multiple Sclerosis (RRMS)?

    <p>Decreased relapse rate (B)</p> Signup and view all the answers

    Which of the following is a second-line option for RRMS patients who do not respond to first-line treatments?

    <p>Fingolimod (B)</p> Signup and view all the answers

    Which drug is commonly prescribed for MS-related pain?

    <p>Duloxetine (A)</p> Signup and view all the answers

    A 30-year-old female presents with symptoms suggestive of multiple sclerosis (MS), confirmed via MRI brain, cerebrospinal fluid analysis, and visual evoked potentials. Which of the following is considered a first-line Disease-Modifying Drug (DMD) for MS?

    <p>Interferon-beta (D)</p> Signup and view all the answers

    What is the primary mechanism of action of Natalizumab in treating MS?

    <p>Blocking immune cell migration across the blood-brain barrier (C)</p> Signup and view all the answers

    Which of the following best describes the effect of Interferon-beta in MS?

    <p>Activates interferon-response genes (B)</p> Signup and view all the answers

    Which drug works by mimicking myelin proteins to induce a shift from Th1 to Th2 response?

    <p>Glatiramer acetate (B)</p> Signup and view all the answers

    How does dimethyl fumarate reduce inflammation in Multiple Sclerosis?

    <p>Activates over 700 nrf2-responsive genes (B)</p> Signup and view all the answers

    Which of the following drugs targets CD52 for the depletion of mature B- and T-cells?

    <p>Alemtuzumab (C)</p> Signup and view all the answers

    What is the primary mechanism of action of fingolimod in MS treatment?

    <p>Prevention of lymphocyte migration to the CNS (C)</p> Signup and view all the answers

    Which drug works by inhibiting the α4-integrin receptor to prevent immune cell migration into the CNS?

    <p>Natalizumab (D)</p> Signup and view all the answers

    Which drug limits pyrimidine availability to reduce immune cell proliferation in MS?

    <p>Teriflunomide (B)</p> Signup and view all the answers

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