CH35: Multiple Sclerosis and Other Demyelinating disease

Question 1

Dominant mechanism in MS (p. 938)

Answer 1

Antibody and complement myelin phagocytosis

Question 2

Histologic subgroups in MS (p. 938)

Answer 2

I: inflammatory lesions made up of T cells and macrophages
II antibody lesion mediated by Ig and complement
III: apoptosis of oligodendrocyte and absence of Ig complement and partial remyelination
IV: oligodendrocyte dystrophy and no remyelination

Question 3

Strongest association is with ___locus on chromosome ___ (p. 939)

Answer 3

DR locus on chromosome 6

Question 4

Inheritable allele for MS

Answer 4

HLA
IL 2Ra
IL7Ra

Question 5

Temporary induction by heat or exercise of symptoms such as unilateral visual blurring (p. 941)

Answer 5

Uthoff phenomenon

Question 6

Flexion of the neck may induce a tingling, electric-like feeling down the shoulders and back (p. 941)

Answer 6

Lhermitte sign

Question 7

An object such as a pendulum that is swinging perpendicular to the patient’s line of sight appears to move in a three- dimensional, circular path (p. 942)

Answer 7

Pulfrich effect

Question 8

Charcot triad (p. 944)

Answer 8

Nystagmus
Scanning speech
Intention tremor

Question 9

In MS, used to control spontaneous attacks (p. 945)

Answer 9

Carbamazepine

Question 10

In MS, blocks the painful tonic spasms that are elicited by hyperventilation (p. 945)

Answer 10

Acetazolamide

Question 11

Seres of concentric rings that represent alternating areas of melin loss and preservation (p.947)

Answer 11

Concentric sclerosis of Balo

Question 12

OCB are only found in how many percent? (p. 948)

Answer 12

90% of cases of MS

Question 13

OCB can also be found in (p.948)

Answer 13

syphilis, Lyme, SSPE

Question 14

IgG index positivity (p. 948)

Answer 14

a positive test is considered to be greater than 12% of the total protein

Question 15

MS vs abscess in CT (p. 949)

Answer 15

C-shaped partial or open ring of abnormal enhancement

Question 16

Is there progressive cerebral atrophy in MS?(p. 949)

Answer 16

Yes

Question 17

Measures the back-scattering of near-infrared light to create extremely high resolution cross- sectional images of the optic nerve and retina (p. 949)

Answer 17

Optical coherence tomography

Question 18

MS and pregnancy (p. 951)

Answer 18

Average relapse rate declines in each trimester reaching a level less than one third of the expected rate by the third trimester

Question 19

Behcet vs MS (p. 952)

Answer 19

In Behcet, recurrent iridocyclitis and meningitis, mucous membrane ulcers of mouth and genitalia; symptoms are articular, renal, lung, and multifocal cerebral disease

Question 20

The first drug of MS (p. 952)

Answer 20

ACTH

Question 21

First interferon for MS (p. 953)

Answer 21

Glutamer acetate

Question 22

In 2006, IV monoclonal antibody for MS (p. 953)

Answer 22

Natalizumab but became limited due to risk of JC virus hence PML

Question 23

Given to patients before taking Interferon (p. 954)

Answer 23

Prednisone 10mgtab 1 hour before

Question 24

A rare side effect of monoclonal antibody for MS (p. 954)

Answer 24

Systemic capillary leak syndrome

Question 25

MOA of Natalizumab (p. 954)

Answer 25

directed against alpha integrin in order to block lymphocyte and monocyte adhesion to endthelial cells and their migration through the vessel wall

Question 26

Murine B cell depleteing monoclonal antibody that targets CD20 (p. 955)

Answer 26

Rituximab

Question 27

Fully humanized anti CD 20 drug (p. 955)

Answer 27

Ocrelizumab

Question 28

A monoclonal antibody which targets CD 52 antigen expressed on T and B lymphocytes (p. 955)

Answer 28

Alemtuzumab

Question 29

A drug that reduces annual relapse rates by approximately one-third to one-half and has gastrointestinal side effects and flushing (p. 955)

Answer 29

Dimethyl fumrate

Question 30

Sphingosine 1 phosphate 1 receptor analogue that interferes with egress of mature lmphocute from lymph node (p. 955)

Answer 30

Fingolimod

Question 31

Suppresses the immune system by inhibiting dihydro-orotate dehydrogenase and suppressing the synthesis of DNA pyrimidine bases (p.955)

Answer 31

Terfunomide

Question 32

Agents such as 4-aminopyridine (p. 956)

Answer 32

improve conduction though demyelinated central nerve fibers by blocking potassum channels

Question 33

Reduce proxysmal symptoms in MS, particularly truncal extensor spasms (p. 956)

Answer 33

Carbamazepine or Gabpentin

Question 34

Alternative to oral baclofen (p. 956)

Answer 34

Tizanidne

Question 35

MS vs NMOSD pathophysio (p. 957)

Answer 35

NMOSD is humoral in contrast to prmarily cellular-immune mechanism in MS

Question 36

In ADEM, how many days the rash does encephalomyelitis occur? (p. 960)

Answer 36

2-4 days