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🧠📖💯 > MS and other Inflammatory Diseases > Flashcards

MS and other Inflammatory Diseases Flashcards

1
Q

[MS Types]

S/sx improve partially or completely
Followed after a variable interval by recurrence or new abnormality in other parts

A) Clinically isolated syndrome
B) Relapsing-remitting pattern
C) Secondary progressive MS
D) Primary progressive MS

A

B) Relapsing-remitting pattern

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2
Q

[MS Types]

Initially relapsing profile becomes steadily progressive in later stages of the disease

A) Clinically isolated syndrome
B) Relapsing-remitting pattern
C) Secondary progressive MS
D) Primary progressive MS

A

C) Secondary progressive MS

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3
Q

[MS Types]

Disease has a steadily progressive course from its initial presentation, esp those more than 40 yo.

A) Clinically isolated syndrome
B) Relapsing-remitting pattern
C) Secondary progressive MS
D) Primary progressive MS

A

D) Primary progressive MS

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4
Q

What are destroyed in acute lesions of MS?

A

Myelin sheaths

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5
Q

What are destroyed in chronic lesions of MS?

A

Axons and neurons

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6
Q

Histologic appearance of long-standing MS lesions

A

Thickly matted, relatively acellular glial tissue

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7
Q

Pathologic appearance of most severe older MS lesions

A

Cavitation

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8
Q

Dominant mechanism of demyelination in MS

A

Antibody and complement-mediated myelin phagocytosis

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9
Q

[MS Histologic Subgroups]

Inflammatory lesions w/ T cells and macrophages

A

Pattern I

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10
Q

[MS Histologic Subgroups]

Apoptosis of oligodendrocytes and absence of Ig or complement.

Partial remyelination

A

Pattern III

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11
Q

[MS Histologic Subgroups]

Autoantibody lesion, Ig and complement

A

Pattern II

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12
Q

[MS Histologic Subgroups]

Oligodendrocyte dystrophy

No remyelination

A

Pattern IV

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13
Q

Peak age at presentation of MS

A

30 years

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14
Q

Strongest genetic association for MS

A

DR locus on chromosome 6

HLA-DR6

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15
Q

Infectious agents associated with MS

A

B. burgdorferi
C. pneumoniae
Herpesvirus type 6

*EBV

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16
Q

In MS, antibodies are directed against (2)?

A

Myelin oligodendrocyte glycoprotein (MOG)

Myelin basic protein (MBP)

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17
Q

MOG and MBP activate what kind of T cells?

A

T cell subset CD41 Th2 cells

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18
Q

What is the Uhthoff phenomenon?

A

Temporary induction by HEAT or EXERCISE of symptoms of MS

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19
Q

What is the Lhermitte sign?

A

Tingling, electric-like feeling down the shoulders and back

2/2 inc sensitivity of demyelinated axons to stretch or pressure

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20
Q

Initial symptom in 1/2 of MS patients

A

Weakness or numbness in one or more limbs

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21
Q

What is the Pulfrich effect

A

Pendulum swinging perpendicularly appears to move in a 3d, circular path

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22
Q

What is the Charcot triad?

A

Nystagmus
Scanning speech
Intention tremor

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23
Q

What is the most common manifestation of progressive MS?

A

Asymmetric spastic paraparesis

Impaired joint position & vibration sense in legs

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24
Q

What is La Belle Indifference?

A

Pathologic cheerfulness in the face of an obvious neurologic deficit

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25
Q

In terms of bladder dysfunction in MS patients, which is more common?

A) Hesitancy, urgency, frequency, incontinence

B) Urinary retention

A

A) Hesitancy, urgency, frequency, incontinence

26
Q

Other diseases that will present with CSF oligoclonal bands

A

MS
Syphilis
Lyme disease
SSPE

27
Q

CSF IgG is considered positive for MS if __% of total protein

A

> 12%

28
Q

4 typical locations of lesions in MS

A

Periventricular
Juxtacortical
Infratentorial
Spinal cord

29
Q

What is the feature most predictive of long-term disability in MS?

A

Degree of disability at 5 years from the first symptom

30
Q

MOA of natalizumab

A

Directed against alpha-integrin

31
Q

Which MS medication is known to be associated the most with PML?

A

Natalizumab

32
Q

Rituximab targets CD__ lymphocytes

A

CD20

33
Q

Alemtuzumab targets CD__

A

CD52

34
Q

Which MS drug is known to cause autoimmune thyroiditis and idiopathic thrombocytopenic purpura?

A

Alemtuzumab

35
Q

MOA of Fingolimod

A

S1P1 receptor analogue

36
Q

Side effects of Fingolimod

A 
Bradycardia, AV block
Macular edema
Melanoma
Herpes infections
Elevated LFT
37
Q

MOA of Teriflunomide

A

Inhibits dihtdro-orotage dehydrogenase

Suppresses synthesis of DNA pyrimidine bases

38
Q

SE of teriflunomide

A

Thinning hair
Teratogenic
Transaminitis

Nasopharyngitis
Diarrhea

39
Q

SE of Glatiramer

A

Flushing
Chest tightness, palpitations
Anxiety

40
Q

Which class of MS drugs is known to induce development of antibodies against it?

A

Interferon beta

41
Q

Which MS drug can cause systemic capillary leak syndrome?

A

Interferon-beta

42
Q

True or false. Treatment with oral prednisone alone slightly increased the risk of new episodes of Optic Neuritis

A

True

43
Q

Use of Amantadine in MS

A

Fatigue tx

44
Q

Antibodies in NMO

A

Aquaporin-4 water channel protein

45
Q

Criteria for NMO

A

2 of the ff:

Longitudinally extensive myelopathy
Positive antibodies
Initial MRI not characteristic of MS

46
Q

NMO affects

A) astrocytes
B) oligodendrocytes

A

A) Astrocytes

47
Q

MS affects

A) astrocytes
B) oligodendrocytes

A

B) oligodendrocytes

48
Q

NMO immunologic process

A) humoral
B) cellular

A

A) humoral

49
Q

MS immunologic process

A) humoral
B) cellular

A

B) cellular

50
Q

Areas of predilection for NMO:

A

Optic nerves
Spinal cord
Brain (area postrema, hypothalamus)

51
Q

Oligoclonal bands are more commonly seen in

A) MS
B) NMO

A

A) MS

52
Q

CSF pleocytosis more commonly seen in

A) MS
B) NMO

A

B) NMO

53
Q

True or false. NMO clinical effects less likely to be permanent

A

False

54
Q

True or fase. Disease modifying agents used in MS may have a deleterious effect on NMO’s relapse rate

A

True

IFN-B, natalizumab, fingolimod

55
Q

Associated infections in ADEM

A

Older:
Measles*, rubella, smallpox, chickenpox

More recent:
EBV, CMV, M. Pneumoniae, HIV

56
Q

ADEM syndrome associated with chickenpox

A

Pure cerebellar syndrome

57
Q

Most fulminant form of demyelinating disease

A

Acute Necrotizing Hemorrhagic Encephalomyelitis / Acute Hemorrhagic Leukoencephalitis of Weston Hurst

58
Q

Focal demyelination of central area of corpus callosum seen in middle-aged chronic alcoholics

A

Marchiafava-Bignami Disease

59
Q

Granular mitosis in reactive astrocytes are called __ cells.

How do you differentiate from gliomas?

A

Creutzfeldt-Peters Cells

Distributed evenly, do not clump together

60
Q

Sharply circumscribed hypocellular plaque. Fibrillary gliosis.

A) Active MS lesion
B) Chronic inactive MS lesion

A

B) Chronic inactive MS lesion

61
Q

Most common form of MS

A

Relapsing-remitting MS

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