CERTIFIED MULTIPLE SCLEROSIS SPECIALIST EXAM PREP (CMSC) | COMPLETE SOLUTIONS |2026 NEWEST UPDATE!!!!!!!!!!

CERTIFIED MULTIPLE SCLEROSIS SPECIALIST EXAM PREP
(CMSC) | COMPLETE SOLUTIONS |2026 NEWEST
UPDATE!!!!!!!!!!
Pathophysiology:vImmunevDysfunctionv-
vcorrectvanswer:vvAnvimpairmentvofvimmunevtolerancevtovcentralvnervousvsystemvtissuevthatvultimatelyvle

adsvtovplaquevformation.



Thevmostvwidelyvbelievedvhypothesisvisvthatvitvisvavvirus-inducedvimmune-mediatedvdisease.



UnusuallyvhighvreactivityvofvimmunevsystemvTvcellsvtovproteinsvofvmyelinvinvthevCNS



Overrepresentationvofvcellsvthatvenhancevimmunevresponsesv(pro-inflammatoryvTvhelpervcells)



PresencevofvimmunevsystemvcellsvinvMSvlesionsvinvthevbrain,vspinalvcord,vandvopticvnerves



Bvlymphocytesvresponsiblevforvproducingvantibodies

Pathophysiology:v

DestructionvofvMyelinvandvAxonalvDamagevorvLossv-
vcorrectvanswer:vvPathologyvofvMSvconsistsvofvlesionsvdisseminatedvinvlocationvandvofvvaryingvage.v


Lesionsvarevpresentvinvbothvwhitevandvgrayvmatter,vgrayvmattervlesionsvarevlessvevident.

Oligodendrocytesvarevdamagedvinvthisvprocess.

Lesionsvrangevfromvacutevplaquesvwithvactivevinflammatoryvinfiltratesvtovchronic,vinactive,vdemyelinatedv
scars.

Slowedvconductionvandvconductionvfailurevoccurvinvdemyelinatedvfibers.vConductionvfailurevisvduevtovfibe
rvfatiguevorvtovanvincreasevinvbodyvtemperature.

Ongoingvinflammation,vdemyelination,vandvscarringvultimatelyvresultvinvirreversiblevaxonalvdamagevandvl
oss.

AcutevMSvlesionsvarevcharacterizedvbyvTvlymphocytes,vplasmavcells,vmacrophages,vandvbare,vdemyelinate
d,vorvtransectedvaxons.

BrainvatrophyvinvMSvrepresentsvavnegativevpathologicvchange.

,TheoriesvofvEtiology:vGeneticsv-
vcorrectvanswer:vvIncreasedvsusceptibilityvisvpresentvinvfamiliesvinvwhichvMSvalreadyvoccurs




Highvgeneticvsusceptibilityvobservedvinvmonozygoticvtwinsv(20%-40%)



SomevgeneticallyvisolatedvgroupsvnevervdevelopvMSv(HutteritesvinvCanada,vEast-EuropeanvGypsies)v



RacialvdifferencesvinvMSvarevlikelyvgeneticallyvbased

TheoriesvofvEtiology:vEnvironmentalv-vcorrectvanswer:vv

TheoriesvofvEtiology:vOtherv-vcorrectvanswer:vv

Epidemiology:vGeographicvDistributionv-
vcorrectvanswer:vvHighvRiskv(>v30vperv100,000):vnorthernvandvcentralvEurope,vItaly,vnorthernvUnitedvState

s,vCanada,vsouthesternvAustralia,vNewvZealand,vpartsvofvformervSovietvUnion



MediumvRiskv(5-
29vperv100,000):vsouthernvEurope,vsouthernvUnitedvStates,vnorthernvAustralia,vnorthernmostvScandinavi
a,vmuchvofvthevnorthvMediterraneanvbasin,vpartsvofvformervSovietvUnion,vwhitevSouthvAfrica,vcentralvSou
thvAmerica



LowvRiskv(<v5vperv100,000):vAfrica,vAsia,vthevCaribbean,vMexico,vnorthernvSouthvAmerica



InvthevUSvstatesvsouthvofvthev37thvparallelvhavevavlowervriskvthanvthosevnorthvofvthevparallel



Peoplevwhovresidevinvtemperatevclimatesvinveconomicallyvdevelopedvwesternvcountriesvtendvtovhavevhig
hervratevofvMS



Thosevoldervthanv15vwhovmigratevretainvthevMSvriskvofvtheirvbirthplace.vThosevmigratingvbeforevagev15va
quirevthevlowervriskvofvthevnewvresidence

Epidemiology:vGenderv-vcorrectvanswer:vvFemalesvhavev3>1vgreatervriskvofvdevelopingvMSv(70-75%)



PPMSv=v50/50

Epidemiology:vAgevofvOnsetv-vcorrectvanswer:vv10-59vyears,vhighestvincidencevbetweenv20-40vyears

, Averagevagevofvonsetvisv28-30vyears

Epidemiology:vEthnicityv-vcorrectvanswer:vvHighestvprevalence:vWhite/Caucasianv

Lowestvprevalence:vJapanese



Asiansvarevmorevlikelyvtovhavevspinalvcordopticvnervevdiseasev(oldervagevonset,vfewervbrainvlesions,vmore
venhancingvlesionsvinvspinalvcord)


DiagnosisvofvMultiplevSclerosis:v

DiagnosticvCriteriav-
vcorrectvanswer:vvMSvisvavclinicalvdiagnosisvbecausevnovdefinitivevlaboratoryvtestvexists.




DiagnosisvofvMSvisvbasedvuponvtwovepisodesvofvneurologicvsymptomsvreferablevtovthevCNSvseparatedvinvs
pacev(differentvlocationvinvthevCNS),vandvtimev(differentvpointvinvtimevforveachvevent).v

ThevrevisedvMcDonaldvcriteriavforvdisseminationvinvtimevarevdetectionvofvGdvenhancementvatvleastv3vmo
nthsvaftervthevonsetvofvthevfirstvclinicalveventvorvdetectionvofvavnewvT2vlesionvappearingvatvanyvtimevcom
paredvwithvavreferencevscanvdonevatvleastv30vdaysvaftervthevonsetvofvthevinitialvclinicalvevent.



RevisedvMcDonaldvcriteria:

1.vTwovattacksvofvdiseasevseparatedvinvspacevandvtime

2.vMustvbevnovbettervexplanation

3.vThreevpossiblevoutcomes:vMultiplevSclerosis,vPossiblevMS,vNotvMS

4.vMonosymptomaticvpresentation:vOnevattack,vOnevobjectivevclinicalvlesion,vMRIvevidence

5.vPrimaryvProgressivevMS:vPositivevCSFvandvdisseminationvinvspace,vMRIvevidencevalongvwithvevokedvpo
tentialsvandvCSF,vContinuedvprogressionvoverv1vyear

6.vDiagnosisvshouldvalwaysvbevmadevinvthevclinicalvcontext

7.vParaclinicalvevidencevalongvwithvMRIvincludesvcerebrospinalvfluidvwithvIgGvoligoclonalvbands

DiagnosisvofvMultiplevSclerosis:v

PresentingvClinicalvSymptomsv-
vcorrectvanswer:vvSymptomaticvdiseasevmeansvneurologicvworseningvinvhevformvofvepisodicvattacksvorvslo

wvprogression.



Thevmostvcommonvpresentationsvarevasvfollows: