Multiple Sclerosis and demielinating diseases Flashcards by Marco Cicero

Lumbar puncture in multiple sclerosis:
a. oligoclonal bands, positive in CSF, negative in serum
b. oligoclonal bands negative in fluid, positive in serum
c. lymphocytosis in the lymph fluid
d. hypoproteinorachia
e. albumin-cytological dissociation

a. oligoclonal bands, positive in CSF, negative in serum

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Not applicable to multiple sclerosis:
a. women get sick more often than men
b. the average age at disease onset is about 30 years
c. the prevalence of the disease is the same worldwide
d. the risk is about 5% if a first-degree relative has the disease

c. the prevalence of the disease is the same worldwide

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There is no pathological feature of multiple sclerosis:
a. spongiform degeneration of the cerebellum
b. plaques of demyelination in the white matter
c. perivascular mononuclear infiltrate in the CNS
d. axon collapse in the central nervous system

a. spongiform degeneration of the cerebellum

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Rarely seen in the clinical picture of multiple sclerosis:
a. Pareses
b. Optic neuritis
c. sensory disturbances
d. hemianopsia

d. hemianopsia

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Progressive multiple sclerosis will be treated with:
a. corticosteroids
b. cytostatics
c. human immunoglobulins
d. interferon beta

b. cytostatics

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The most characteristic finding in the liquor of multiple sclerosis is:
a. Increased protein concentration
b. increased cell count
c. elevated IgG index (=(IgGi /albumini )/(IgGs /albumins ); elevated: > 0,7)
d. oligoclonal bands present

d. oligoclonal bands present

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The relapsing-remitting form of multiple sclerosis will be treated with:
a. corticosteroids
b. cytostatics
c. human immunoglobulins
d. interferon beta

d. interferon beta

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Neuromyelitis is not covered by optics:
a. eponym is Devic’s disease
b. neuromyelitis optica affects the optic nerves and spinal cord
c. neuromyelitis is a demyelinating disease of the central nervous system
d. myelitis in the syndrome is usually partial with predominantly
sensory fibre involvement

d. myelitis in the syndrome is usually partial with predominantly
sensory fibre involvement

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A 70-year-old gentleman has difficulty walking (ataxic), is forgetful. On
examination, hyperreflexia of the upper and lower limbs is found, positional
sensitivity is also disturbed (+ there was something else). What is it:
a. Parkinson’s disease
b. Alzheimer’s disease
c. multiple sclerosis
d. subacute combined degeneration of the spinal cord
e. diabetic polyneuropathy

d. subacute combined degeneration of the spinal cord

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Acute disseminated encephalomyelitis (ADEM) is not covered:
a. vaccination occurrences
b. occurs after infection
c. is more common in adults than in children
d. is a monophasic disease of the central nervous system

c. is more common in adults than in children

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Neuromyelitis optica is caused by antibodies:
a. against aquaporin
b. against Na/K/Ca - tubules

a. against aquaporin

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Lhermitis sign (in a third of patients) means:
a. electrification along the spine and upper limbs when moving the head
b. worsening of neurological symptoms from fever
c. visual impairment with fatigue
d. tonic, recurrent limb cramps

a. electrification along the spine and upper limbs when moving the head

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In MS only rarely will we find:
a. depression
b. erectile dysfunction
c. handicap
d. paraplegia

d. paraplegia

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The characteristic micturition disturbance of a Th5 demyelinating plaque is absent:
a. Emergency
b. atonic bladder (reduced tone)
c. frequency
d. detrusor-sphincter dyssynergy

b. atonic bladder (reduced tone)

That would be LMN disease

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How do we treat a hyperexcitable bladder in MS?
a. anticholinergics (oxybutynin, imipramine, tolterodine)

a. anticholinergics (oxybutynin, imipramine, tolterodine)

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What do “black holes” on MRI in MS mean?
a. demienilisation
b. inflammation
c. axonal collapse (this indicates the presence of irreversible neurological
signs causing more severe impairment)

c. axonal collapse (this indicates the presence of irreversible neurological
signs causing more severe impairment)

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What is the most effective treatment for fatigue in MS?
a. amantadine
b. interferon beta
c. betacarotene

a. amantadine

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The minimum information we need to diagnose MS is:
a. MR
b. evoked potentials
c. Liquor examination
d. EMG
e. clinical examination of the pupils

d. EMG

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There is no side effect of interferon beta:
a. Chest pain

a. Chest pain

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NU azathioprine:
a. osteoporosis
b. liver damage
c. gastric ulcer
d. hypertension

b. liver damage

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An MS epidemic has been described at:
a. Faroe Islands

a. Faroe Islands

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ADEM-specific test results include:
a. extensive symmetrical changes on head MRI in both hemispheres
b. meningitic fluid
c. Negative oligoclonal bands in the lymphocyte after remission of the disease
d. all of the above

d. all of the above

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Which country has the highest prevalence of MS:
a. Australia
b. Slovenia
c. Austria
d. Scotland

d. Scotland

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What is not true:
a. with relapsing-remitting form, multiple sclerosis starts in 85% of patients
b. a clinically isolated syndrome always leads to MS
c. the primary progressive form is relatively more common in middle-aged men
d. after 10 years of disease, the relapsing-remitting form progresses
to the secondary progressive form of MS in 50% of patients

b. a clinically isolated syndrome always leads to MS

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In a patient with MS, we will find: a. oligoclonal strips

a. oligoclonal strips

Which medicine is not given for symptomatic treatment of MS? a. interferon beta b. NSAIDS c. baclofen d. botulinum

a. interferon beta

The best test for multiple sclerosis? a. MRI of the head b. visible evoked potentials c. lumbar puncture

a. MRI of the head

What do we not see in multiple sclerosis? a. the pocket knife phenomenon b. The sign of the Lhermites c. the toothed wheel phenomenon

c. the toothed wheel phenomenon

Which forms of MS should not be treated with interferon beta: a. isolated clinical syndrome b. relapsing-remitting c. Secondary progressive d. primary progressive e. all could be treated with interferon beta

d. primary progressive

What signs do we see in MS? Optic neuritis, colour blindness, diplopia, Lhermitte's sign, gait ataxia, transient paresis and paresthesias of the limbs, useless hand syndrome, nystagmus, intention tremor, scant speech (last three = Charcot's trias)

Optic neuritis, colour blindness, diplopia, Lhermitte's sign, gait ataxia, transient paresis and paresthesias of the limbs, useless hand syndrome, nystagmus, intention tremor, scant speech (last three = Charcot's trias)

Circle the correct statement about multiple sclerosis: a. occurrence after the age of 45 b. more common in Finland than in Italy

b. more common in Finland than in Italy

Which is not an immunomodulatory drug for multiple sclerosis? a. prednisolone b. beta-interferon c. glatiramer acetate d. fingolimod

d. fingolimod

Who does not have MS: a. patient with no signs on brain MRI b. patient with no signs on MRI of the spinal cord c. oligoclonal bands are not present in the lysate d. a patient who has no symptoms

d. a patient who has no symptoms

Woman with MS, no longer responding to IFN beta, what should we give her? a. Natalizumab

a. Natalizumab

When can we diagnose MS? a. at the first clinical exacerbation with typical test and imaging results

a. at the first clinical exacerbation with typical test and imaging results

What is a common first sign of MS? a. in the spinal cord b. loss of vision in one eye

a. in the spinal cord

Which tests confirm MS: a. MRI b. lumbar puncture c. visual evoked potentials

a. MRI

Circle the incorrect statement about multiple sclerosis: a. muscarinic agonists are given to treat bladder dysfunction

a. muscarinic agonists are given to treat bladder dysfunction

Which statement is true for multiple sclerosis: a. is more severe in women b. cannot be for under 16s c. MRI is the preferred diagnostic method d. the progressive form can be successfully treated

c. MRI is the preferred diagnostic method

In MS we see: a. ataxia, hyperreflexia, urinary incontinence b. the others always had one LMN option

a. ataxia, hyperreflexia, urinary incontinence

A patient who had optic neuritis a year ago now has some symptoms of spasticity: a. MS.

a. MS.

Which patient will not be treated with interferons? a. Primary progressive MS b. Secondary progressive MS with triggers c. relapsing-remitting MS

a. Primary progressive MS

Where is MS most common: a. Slovenia b. Italy c. Norway

c. Norway

Which statement is not true? a. gadolinium contrast agent staining of active demyelinating lesions on MRI is due to a broken blood-brain barrier b. MS is the only disease that results in demyelinating changes in the brain c. demyelinating lesions have increased signal on T2-weighted and FLAIRweighted MRI sequences d. MS is characterised by demyelinating changes at the callososeptal border e. demyelinating changes in MS can also be in the cerebral cortex

b. MS is the only disease that results in demyelinating changes in the brain

Circle the two correct statements for multiple sclerosis: a. the most empirically supported aetiological hypothesis for MS causally links changes in blood flow through the cerebral vasculature to subsequent myelin sheath injury b. the most empirically supported aetiological hypothesis for MS causally links the immune system/development of autoimmunity to subsequent myelin sheath damage c. the most empirically supported aetiological hypothesis for MS causally links infectious causes to subsequent myelin sheath damage d. the three most important diagnostic procedures are MRI, EEG, visual evoked potentials e. the three most important diagnostic procedures are MRI, visual evoked potentials, and liquor diagnostics

b. the most empirically supported aetiological hypothesis for MS causally links the immune system/development of autoimmunity to subsequent myelin sheath damage e. the three most important diagnostic procedures are MRI, visual evoked potentials, and liquor diagnostics

A 42-year-old patient reports the following in the last 6 months: difficulty walking, leg and arm cramps, speech and swallowing difficulties. On examination: increased spasticity of upper and lower limbs, dysarthria, decreased sensation on the back of the right hand, reports tingling sensation over the face, reflexes on the face are normal, on the lower limbs they are accentuated. MMSE 27/30. In view of the above, please circle the option with the appropriate initial differential diagnostic workup a. ALS or neoplasm; order EMG and MRI b. ALS or MS; order EMG and MRI c. neoplasm, MS or infections; order MRI, serum and liver tests for infections, VEP d. Parkinson's disease or MS; levodopa test and MRI e. Parkinson's disease or MS; levodopa test, order MRI, EMG

c. neoplasm, MS or infections; order MRI, serum and liver tests for infections, VEP

Which of the following drugs is not used in the symptomatic treatment of patients with multiple sclerosis? a. baclofen b. antidepressants c. NSAIDs d. interferon beta e. symptomatic treatment using all the medicines listed below

d. interferon beta

What do we call the worsening of symptoms of multiple sclerosis when the temperature rises? a. The Uhthoff phenomenon.

a. The Uhthoff phenomenon.

Which disease does not have a monogenic inheritance pattern? a. Alzheimer's disease b. Parkinson's disease c. multiple sclerosis d. migraine

c. multiple sclerosis

Treatment of spasticity in MS: a. baclofen b. benzodiazepines c. tizanidine d. botulinum e. all of the above

e. all of the above

Multiple sclerosis: a. Prevalence 800/100,000 b. occurs later in men c. most common in Mediterranean countries d. highest incidence at age 45 (between 20 and 40 years) e. diagnosed on average at age 40 (between 20 and 40 years)

b. occurs later in men

Multiple sclerosis is: a. it is more common in the northern hemisphere

a. it is more common in the northern hemisphere

One MR image, demyelinating lesions around the ventricles: a. multiple sclerosis

a. multiple sclerosis

Demyelination is most commonly caused by: a. autoimmune disorders b. genetic disorders c. vascular disorders d. toxic disorders

a. autoimmune disorders

What is a typical patient with primary progressive multiple sclerosis like? a. 44-year-old man

a. 44-year-old man

Where are the most characteristic lesions in MS? a. periventricular

a. periventricular

What is characteristic of ADEM (circle the wrong statement)? a. after measles vaccination b. in children c. oligoclonal bands present after remission

c. oligoclonal bands present after remission

The prevalence of multiple sclerosis is a. 100/100.000 b. 800/100.000 c. 1/100.000 d. 10/100.00

a. 100/100.000

A 35-year-old woman. The patient has a fluid effusion pressure of 150 mmH2O, a fluid protein concentration of 0,35 g/L, 7 mononuclear cells/mm3 and a blood glucose concentration of 3,6 mmol/L (normal blood). Oligoclonal bands are present in the fluid and negative in the serum. What is wrong with her? a. Multiple sclerosis b. ADEM c. purulent bacterial meningitis d. ALS

a. Multiple sclerosis

We will find antibodies in a patient who lost her sight months ago and is paretic: a. anti-Yo b. anti-Hu c. anti-NMO d. anti-Ma2 e. anti-MuSK

c. anti-NMO

What is the prevalence of multiple sclerosis linked to? a. smoking b. drinking alcohol c. Carrying your phone in your pocket d. chocolate e. excessive sunbathing

a. smoking

A 50-year-old man with advanced multiple sclerosis. Which of the banned substances would help with pain and rigidity? a. cannabis b. heroin c. amphetamines d. cocaine e. LSD

a. cannabis

Which statement about multiple sclerosis is true? a. 40% of patients have a benign form - 20% are right b. 80% have a primary progressive form - 10-20% is right c. 10% have secondary progressive form - 50-70% is correct d. 40% of patients have relapsing-remitting type

d. 40% of patients have relapsing-remitting type

The following applies to the diagnosis of multiple sclerosis: a. MRI is the gold standard b. we see changes in the corpus callosum c. change spreads over time and space d. after gadolinium staining, the lesions stain hyperintensely e. all of the above are true

e. all of the above are true

Which vitamin deficiency is associated with multiple sclerosis? a. B vitamins b. vitamin A c. vitamin D d. vitamin E e. vitamin K

c. vitamin D