CERTIFIED MULTIPLE SCLEROSIS SPECIALIST EXAM PREP QUESTIONS COMPLETE WITH 100% VERIFIED ANSWERS

CERTIFIED MULTIPLE SCLEROSIS SPECIALIST EXAM PREP QUESTIONS COMPLETE WITH 100% VERIFIED ANSWERS Q.Pathophysiology: Immune Dysfunction - ANSWERS-An impairment of immune tolerance to central nervous system tissue that ultimately leads to plaque formation The most widely believed hypothesis is that it is a virus-induced immune-mediated disease. Unusually high reactivity of immune system T cells to proteins of myelin in the CNS Overrepresentation of cells that enhance immune responses (pro-inflammatory T helper cells) Presence of immune system cells in MS lesions in the brain, spinal cord, and optic nerves B lymphocytes responsible for producing antibodies Q.Pathophysiology: Destruction of Myelin and Axonal Damage or Loss - ANSWERS-Pathology of MS consists of lesions disseminated in location and of varying age. Lesions are present in both white and gray matter, gray matter lesions are less evident. Oligodendrocytes are damaged in this process. Lesions range from acute plaques with active inflammatory infiltrates to chronic, inactive, demyelinated scars. Slowed conduction and conduction failure occur in demyelinated fibers. Conduction failure is due to fiber fatigue or to an increase in body temperature. Ongoing inflammation, demyelination, and scarring ultimately result in irreversible axonal damage and loss. Acute MS lesions are characterized by T lymphocytes, plasma cells, macrophages, and bare, demyelinated, or transected axons. Brain atrophy in MS represents a negative pathologic change. Q.Theories of Etiology: Genetics - ANSWERS-Increased susceptibility is present in families in which MS already occurs High genetic susceptibility observed in monozygotic twins (20%-40%) Some genetically isolated groups never develop MS (Hutterites in Canada, East-European Gypsies) Racial differences in MS are likely genetically based Q.Epidemiology: Geographic Distribution - ANSWERS-High Risk ( 30 per 100,000): northern and central Europe, Italy, northern United States, Canada, southestern Australia, New Zealand, parts of former Soviet Union Medium Risk (5-29 per 100,000): southern Europe, southern United States, northern Australia, northernmost Scandinavia, much of the north Mediterranean basin, parts of former Soviet Union, white South Africa, central South America Low Risk ( 5 per 100,000): Africa, Asia, the Caribbean, Mexico, northern South America In the US states south of the 37th parallel have a lower risk than those north of the parallel People who reside in temperate climates in economically developed western countries tend to have higher rate of MS Those older than 15 who migrate retain the MS risk of their birthplace. Those migrating before age 15 aquire the lower risk of the new residence Q.Epidemiology: Gender - ANSWERS-Females have 31 greater risk of developing MS (70-75%) PPMS = 50/50 Q.Epidemiology: Age of Onset - ANSWERS-10-59 years, highest incidence between 20-40 years Average age of onset is 28-30 years Q.Epidemiology: Ethnicity - ANSWERS-Highest prevalence: White/Caucasian Lowest prevalence: Japanese Asians are more likely to have spinal cordoptic nerve disease (older age onset, fewer brain lesions, more enhancing lesions in spinal cord) Q.Diagnosis of Multiple Sclerosis: Diagnostic Criteria - ANSWERS-MS is a clinical diagnosis because no definitive laboratory test exists. Diagnosis of MS is based upon two episodes of neurologic symptoms referable to the CNS separated in space (different location in the CNS), and time (different point in time for each event). The revised McDonald criteria for dissemination in time are detection of Gd enhancement at least 3 months after the onset of the first clinical event or detection of a new T2 lesion appearing at any time compared with a reference scan done at least 30 days after the onset of the initial clinical event. Revised McDonald criteria: 1. Two attacks of disease separated in space and time 2. Must be no better explanation 3. Three possible outcomes: Multiple Sclerosis, Possible MS, Not MS 4. Monosymptomatic presentation: One attack, One objective clinical lesion, MRI evidence 5. Primary Progressive MS: Positive CSF and dissemination in space, MRI evidence along with evoked potentials and CSF, Continued progression over 1 year 6. Diagnosis should always be made in the clinical context 7. Paraclinical evidence along with MRI includes cerebrospinal fluid with IgG oligoclonal bands Q.Diagnosis of Multiple Sclerosis: Presenting Clinical Symptoms - ANSWERS-Symptomatic disease means neurologic worsening in he form of episodic attacks or slow progression. The most common presentations are as follows: Sensory disturbance such as numbness, paresthesias, pain, or Lhermitte's sign (21% to 55% of patients) Often begins in the limbs and migrates proximally Tingling