1
ADVANCED PATHOPHYSIOLOGY FINAL 2024
UPDATED EXAM (600 QUESTIONS AND
SOLUTION)100% PASS.
Do women or men more often have multiple sclerosis? - Solution Women (2-3:1)
Which disease has the following risk factors:
-Epstein-barr virus (EBV)
-Live above the 37th parallel
-Caucasian
-Female
-Vitamin D deficiency: Decreased time between clinical isolated syndrome (CIS) and 2nd
exacerbation
-Smoking - Solution Multiple Sclerosis
What is the main pathophysiological theory for multiple sclerosis? - Solution It's an
autoimmune/neurodegenerative disease:
-inflammation
-demyelination/remyelination
-permanent axonal damage
What are the Myelin forming cells of the CNS? - Solution Oligodendrocytes
What do T-Helper cell types 1 & 17 do? - Solution Pro-inflammatory
What does T-Helper cell type 2 do? - Solution Anti-inflammatory
What is the pathophysiology of Multple Sclerosis? - Solution 1. Autoreactive T cells express
Very Late Antegen-4 (VLA-4, aka α4-integrin) on their cell surface and secrete Matrix
Metalloproteinases (MMP).
2. VLA-4 binds to Vascular Cell Adhesion Molecule (VCAM) receptors on the blood brain
barrier (BBB) and MMP results in dysregulation of the BBB, allowing cell entry into the CNS.
3. Once in the CNS, pro-inflammatory cytokines (TNF-α, INF-γ, and Osteopontin [OP]) are
secreted resulting in inflammation and further T cell entry into the CNS.
4. T cells in the CNS interact with microglia, astrocytes, and macrophages to produce reactive
oxygen species and nitric oxide causing CNS damage.
5. B cells acts as ACPs, enter the CNS, and produce myelin-specific antibodies that form
membrane attack complexes with complement causing cell lysis.
, 2
Which disease presents in the following way:
**Visual changes, optic neuritis (Often the 1st sign/symptom)
-Paresthesias
-Gait issues/falls
-Foot drop
-Dysdiadochokinesia
-Fatigue
-Weakness
-Impaired coordination
-Cognitive changes
MRI:
***Gadolinium enhanced lesions
LUMBAR PUNCTURE TEST:
-Increased IgG
-Increased Myelin basic protein (MBP)
-Increased CSF protein - Solution Multiple Sclerosis
Which cognitive test is most commonly used to diagnose MS? - Solution Symbol Digit
Modalities Test (SDMT)
What is the primary diagnostic test for MS? - Solution MRI with or without contrast
What is the most common type of MS, which is involves episodes of acute worsening with some
recovery and no progression in between exacerbations? - Solution Relapsing Remitting MS
(RRMS)
What type of MS can develop from RRMS, have a steady progression of the disease in between
exacerbations, and present with more black holes and brain atrophy? - Solution Secondary
Progressive MS (SPMS)
What type of MS is the least common, it doesn't develop from RRMS and is the progressive
worsening of the disease from the start, lacking recovery times? - Solution Primary Progressive
MS (PPMS)
What is the prognosis (good or bad) for someone with MS who is:
- under 40 years old
-Female
-First sign/symptom is optic neuritis/sensory issues
-Low exacerbation frequency
-RRMS
-Single lesion - Solution Good prognosis
What is the prognosis (good or bad) for someone with MS who is:
- over 40 years old
, 3
-Male
-First sign/symptom is motor or cerebellar
-Multiple lesion locations
-PPMS - Solution Bad prognosis
What are the treatment goals for treating MS? - Solution -Decrease attack/exacerbation rate
-Decrease annualized relapse rate (ARR)
-Slow progression of disease
-Prevent/limit ADRs
-Symptom management (fatigue, bladder dysfunction, cognitive dysfunction, constipation,
depression)
When monitoring MS patients should follow-up with their neurologists every _________. Get an
MRI every ___________. - Solution When monitoring MS patients should follow-up with their
neurologists every 6 months-1 year. Get an MRI every 1 year (based on need).
What is the difference between seizure and epilepsy? - Solution Seizure: a discrete clinical event
that results in the abnormal synchronous discharge of a set of neurons in the brain.
Epilepsy: at least 2 unprovoked seizures occurring more than 24 hours apart.
What is Status Epilepticus? - Solution Failure of the termination mechanisms for seizure leading
to abnormally prolonged seizures. Length of seizure beyond 5 minutes and duration beyond the
risk of long-term consequence (30 minutes).
Which part of the brain is responsible for visual memory, organizing sensory information,
emotional responses? - Solution Temporal lobe
Which lobe of the brain is responsible for sensations (touch, feeling pain, spacial
representation)? - Solution Parietal lobe
Which part of the brain is responsible for planning, abstract thinking, organizing, reward system,
pleasure? - Solution Frontal Lobe
Which part of the brain is responsible for vision? - Solution Occipital lobe
Which part of the brain is responsible for voluntary movement (face, neck, trunk, upper/lower
extremities)? - Solution Motor Cortex
Which part of the brain is responsible for sensations of tingling, numbness, touch, smell of burnt
rubber, parasthesisas? - Solution Somatosensory Cortex
Which part of the brain is responsible for speech? and which part is responsible for speech terms
of the formation of thoughts and word? - Solution Broca's: speech
Wernicke's: formation of thought/words
, 4
Which part of the brain is responsible for hearing? - Solution Auditory Cortex
Which part of the brain is responsible for sensory information processing, perceptual
disturbances? - Solution Association Cortex
When does Epilepsy most often present in patients? - Solution Most often in infancy and
childhood
What are the International League Against Epilepsy (ILAE) Epilepsy etiologies? - Solution 1.
Genetic
2. Structural
3. Infectious
4. Metabolic
5. Immune
6. Unknown
What is the pathophysiology of Seizures? - Solution 1. Excessive excitation of cortical neurons
(hyperexcitable/hypersynchronization)
-Abnormal functioning of Na/K pump, ligand-activated channels, voltage-gated channels.
-Abnormal ATPase functioning
-Abnormal synaptic vesicle protein 2-A
-Changes in receptors, second messaging systems
2. Disorder inhibition of cortical neurons
3. Transitory imbalance in neurotransmitters
-Enhanced excitatory neurotransmission (Glutamate/Aspartate, and NMDA/AMPA receptors)
What are some seizure recurrence risk factors? - Solution -Abnormal EEG
-Seizure occurs during sleep
-Family history
-Prior acute seizure
-Mental retardation or cerebral palsy
*NOT seizure type
*NOT seizure length
*NOT age of onset
What type of seizure involves one hemisphere of the brain and may be with or without
dyscognitive features. - Solution Focal Seizures
What type of seizure involves the loss of consciousness for 5-20 seconds but the patient does not
lose postural control? - Solution Absence Seizure
What type of seizure involves bilateral muscle jerks and twitching? - Solution Myoclonic
Seizure
ADVANCED PATHOPHYSIOLOGY FINAL 2024
UPDATED EXAM (600 QUESTIONS AND
SOLUTION)100% PASS.
Do women or men more often have multiple sclerosis? - Solution Women (2-3:1)
Which disease has the following risk factors:
-Epstein-barr virus (EBV)
-Live above the 37th parallel
-Caucasian
-Female
-Vitamin D deficiency: Decreased time between clinical isolated syndrome (CIS) and 2nd
exacerbation
-Smoking - Solution Multiple Sclerosis
What is the main pathophysiological theory for multiple sclerosis? - Solution It's an
autoimmune/neurodegenerative disease:
-inflammation
-demyelination/remyelination
-permanent axonal damage
What are the Myelin forming cells of the CNS? - Solution Oligodendrocytes
What do T-Helper cell types 1 & 17 do? - Solution Pro-inflammatory
What does T-Helper cell type 2 do? - Solution Anti-inflammatory
What is the pathophysiology of Multple Sclerosis? - Solution 1. Autoreactive T cells express
Very Late Antegen-4 (VLA-4, aka α4-integrin) on their cell surface and secrete Matrix
Metalloproteinases (MMP).
2. VLA-4 binds to Vascular Cell Adhesion Molecule (VCAM) receptors on the blood brain
barrier (BBB) and MMP results in dysregulation of the BBB, allowing cell entry into the CNS.
3. Once in the CNS, pro-inflammatory cytokines (TNF-α, INF-γ, and Osteopontin [OP]) are
secreted resulting in inflammation and further T cell entry into the CNS.
4. T cells in the CNS interact with microglia, astrocytes, and macrophages to produce reactive
oxygen species and nitric oxide causing CNS damage.
5. B cells acts as ACPs, enter the CNS, and produce myelin-specific antibodies that form
membrane attack complexes with complement causing cell lysis.
, 2
Which disease presents in the following way:
**Visual changes, optic neuritis (Often the 1st sign/symptom)
-Paresthesias
-Gait issues/falls
-Foot drop
-Dysdiadochokinesia
-Fatigue
-Weakness
-Impaired coordination
-Cognitive changes
MRI:
***Gadolinium enhanced lesions
LUMBAR PUNCTURE TEST:
-Increased IgG
-Increased Myelin basic protein (MBP)
-Increased CSF protein - Solution Multiple Sclerosis
Which cognitive test is most commonly used to diagnose MS? - Solution Symbol Digit
Modalities Test (SDMT)
What is the primary diagnostic test for MS? - Solution MRI with or without contrast
What is the most common type of MS, which is involves episodes of acute worsening with some
recovery and no progression in between exacerbations? - Solution Relapsing Remitting MS
(RRMS)
What type of MS can develop from RRMS, have a steady progression of the disease in between
exacerbations, and present with more black holes and brain atrophy? - Solution Secondary
Progressive MS (SPMS)
What type of MS is the least common, it doesn't develop from RRMS and is the progressive
worsening of the disease from the start, lacking recovery times? - Solution Primary Progressive
MS (PPMS)
What is the prognosis (good or bad) for someone with MS who is:
- under 40 years old
-Female
-First sign/symptom is optic neuritis/sensory issues
-Low exacerbation frequency
-RRMS
-Single lesion - Solution Good prognosis
What is the prognosis (good or bad) for someone with MS who is:
- over 40 years old
, 3
-Male
-First sign/symptom is motor or cerebellar
-Multiple lesion locations
-PPMS - Solution Bad prognosis
What are the treatment goals for treating MS? - Solution -Decrease attack/exacerbation rate
-Decrease annualized relapse rate (ARR)
-Slow progression of disease
-Prevent/limit ADRs
-Symptom management (fatigue, bladder dysfunction, cognitive dysfunction, constipation,
depression)
When monitoring MS patients should follow-up with their neurologists every _________. Get an
MRI every ___________. - Solution When monitoring MS patients should follow-up with their
neurologists every 6 months-1 year. Get an MRI every 1 year (based on need).
What is the difference between seizure and epilepsy? - Solution Seizure: a discrete clinical event
that results in the abnormal synchronous discharge of a set of neurons in the brain.
Epilepsy: at least 2 unprovoked seizures occurring more than 24 hours apart.
What is Status Epilepticus? - Solution Failure of the termination mechanisms for seizure leading
to abnormally prolonged seizures. Length of seizure beyond 5 minutes and duration beyond the
risk of long-term consequence (30 minutes).
Which part of the brain is responsible for visual memory, organizing sensory information,
emotional responses? - Solution Temporal lobe
Which lobe of the brain is responsible for sensations (touch, feeling pain, spacial
representation)? - Solution Parietal lobe
Which part of the brain is responsible for planning, abstract thinking, organizing, reward system,
pleasure? - Solution Frontal Lobe
Which part of the brain is responsible for vision? - Solution Occipital lobe
Which part of the brain is responsible for voluntary movement (face, neck, trunk, upper/lower
extremities)? - Solution Motor Cortex
Which part of the brain is responsible for sensations of tingling, numbness, touch, smell of burnt
rubber, parasthesisas? - Solution Somatosensory Cortex
Which part of the brain is responsible for speech? and which part is responsible for speech terms
of the formation of thoughts and word? - Solution Broca's: speech
Wernicke's: formation of thought/words
, 4
Which part of the brain is responsible for hearing? - Solution Auditory Cortex
Which part of the brain is responsible for sensory information processing, perceptual
disturbances? - Solution Association Cortex
When does Epilepsy most often present in patients? - Solution Most often in infancy and
childhood
What are the International League Against Epilepsy (ILAE) Epilepsy etiologies? - Solution 1.
Genetic
2. Structural
3. Infectious
4. Metabolic
5. Immune
6. Unknown
What is the pathophysiology of Seizures? - Solution 1. Excessive excitation of cortical neurons
(hyperexcitable/hypersynchronization)
-Abnormal functioning of Na/K pump, ligand-activated channels, voltage-gated channels.
-Abnormal ATPase functioning
-Abnormal synaptic vesicle protein 2-A
-Changes in receptors, second messaging systems
2. Disorder inhibition of cortical neurons
3. Transitory imbalance in neurotransmitters
-Enhanced excitatory neurotransmission (Glutamate/Aspartate, and NMDA/AMPA receptors)
What are some seizure recurrence risk factors? - Solution -Abnormal EEG
-Seizure occurs during sleep
-Family history
-Prior acute seizure
-Mental retardation or cerebral palsy
*NOT seizure type
*NOT seizure length
*NOT age of onset
What type of seizure involves one hemisphere of the brain and may be with or without
dyscognitive features. - Solution Focal Seizures
What type of seizure involves the loss of consciousness for 5-20 seconds but the patient does not
lose postural control? - Solution Absence Seizure
What type of seizure involves bilateral muscle jerks and twitching? - Solution Myoclonic
Seizure
