CERTIFIED MULTIPLE SCLEROSIS SPECIALIST EXAM
PREP (CMSC) | COMPLETE SOLUTIONS!!!!!!!!
Pathophysiology:,Immune,Dysfunction,-
,Answer,:,,An,impairment,of,immune,tolerance,to,central,nervous,system,tissue,that,ultimately,leads,to,plaqu
e,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
Pathophysiology:,
Destruction,of,Myelin,and,Axonal,Damage,or,Loss,-
,Answer,:,,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,scar
s.
Slowed,conduction,and,conduction,failure,occur,in,demyelinated,fibers.,Conduction,failure,is,due,to,fiber,fati
gue,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,,o
r,transected,axons.
Brain,atrophy,in,MS,represents,a,negative,pathologic,change.
Theories,of,Etiology:,Genetics,-
,Answer,:,,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
Theories,of,Etiology:,Environmental,-,Answer,:,,
Theories,of,Etiology:,Other,-,Answer,:,,
Epidemiology:,Geographic,Distribution,-
,Answer,:,,High,Risk,(>,30,per,100,000):,northern,and,central,Europe,,Italy,,northern,United,States,,Canada,,so
uthestern,Australia,,New,Zealand,,parts,of,former,Soviet,Union
Medium,Risk,(5-
29,per,100,000):,southern,Europe,,southern,United,States,,northern,Australia,,northernmost,Scandinavia,,m
uch,of,the,north,Mediterranean,basin,,parts,of,former,Soviet,Union,,white,South,Africa,,central,South,Americ
a
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,r
ate,of,MS
Those,older,than,15,who,migrate,retain,the,MS,risk,of,their,birthplace.,Those,migrating,before,age,15,aquire,t
he,lower,risk,of,the,new,residence
Epidemiology:,Gender,-,Answer,:,,Females,have,3>1,greater,risk,of,developing,MS,(70-75%)
PPMS,=,50/50
Epidemiology:,Age,of,Onset,-,Answer,:,,10-59,years,,highest,incidence,between,20-40,years
Average,age,of,onset,is,28-30,years
, Epidemiology:,Ethnicity,-,Answer,:,,Highest,prevalence:,White/Caucasian,
Lowest,prevalence:,Japanese
Asians,are,more,likely,to,have,spinal,cordoptic,nerve,disease,(older,age,onset,,fewer,brain,lesions,,more,enha
ncing,lesions,in,spinal,cord)
Diagnosis,of,Multiple,Sclerosis:,
Diagnostic,Criteria,-,Answer,:,,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,a
fter,the,onset,of,the,first,clinical,event,or,detection,of,a,new,T2,lesion,appearing,at,any,time,compared,with,a,r
eference,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,potenti
als,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
Diagnosis,of,Multiple,Sclerosis:,
Presenting,Clinical,Symptoms,-
,Answer,:,,Symptomatic,disease,means,neurologic,worsening,in,he,form,of,episodic,attacks,or,slow,progressio
n.
The,most,common,presentations,are,as,follows:
Sensory,disturbance,such,as,numbness,,paresthesias,,pain,,or,Lhermitte's,sign,(21%,to,55%,of,patients)
PREP (CMSC) | COMPLETE SOLUTIONS!!!!!!!!
Pathophysiology:,Immune,Dysfunction,-
,Answer,:,,An,impairment,of,immune,tolerance,to,central,nervous,system,tissue,that,ultimately,leads,to,plaqu
e,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
Pathophysiology:,
Destruction,of,Myelin,and,Axonal,Damage,or,Loss,-
,Answer,:,,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,scar
s.
Slowed,conduction,and,conduction,failure,occur,in,demyelinated,fibers.,Conduction,failure,is,due,to,fiber,fati
gue,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,,o
r,transected,axons.
Brain,atrophy,in,MS,represents,a,negative,pathologic,change.
Theories,of,Etiology:,Genetics,-
,Answer,:,,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
Theories,of,Etiology:,Environmental,-,Answer,:,,
Theories,of,Etiology:,Other,-,Answer,:,,
Epidemiology:,Geographic,Distribution,-
,Answer,:,,High,Risk,(>,30,per,100,000):,northern,and,central,Europe,,Italy,,northern,United,States,,Canada,,so
uthestern,Australia,,New,Zealand,,parts,of,former,Soviet,Union
Medium,Risk,(5-
29,per,100,000):,southern,Europe,,southern,United,States,,northern,Australia,,northernmost,Scandinavia,,m
uch,of,the,north,Mediterranean,basin,,parts,of,former,Soviet,Union,,white,South,Africa,,central,South,Americ
a
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,r
ate,of,MS
Those,older,than,15,who,migrate,retain,the,MS,risk,of,their,birthplace.,Those,migrating,before,age,15,aquire,t
he,lower,risk,of,the,new,residence
Epidemiology:,Gender,-,Answer,:,,Females,have,3>1,greater,risk,of,developing,MS,(70-75%)
PPMS,=,50/50
Epidemiology:,Age,of,Onset,-,Answer,:,,10-59,years,,highest,incidence,between,20-40,years
Average,age,of,onset,is,28-30,years
, Epidemiology:,Ethnicity,-,Answer,:,,Highest,prevalence:,White/Caucasian,
Lowest,prevalence:,Japanese
Asians,are,more,likely,to,have,spinal,cordoptic,nerve,disease,(older,age,onset,,fewer,brain,lesions,,more,enha
ncing,lesions,in,spinal,cord)
Diagnosis,of,Multiple,Sclerosis:,
Diagnostic,Criteria,-,Answer,:,,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,a
fter,the,onset,of,the,first,clinical,event,or,detection,of,a,new,T2,lesion,appearing,at,any,time,compared,with,a,r
eference,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,potenti
als,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
Diagnosis,of,Multiple,Sclerosis:,
Presenting,Clinical,Symptoms,-
,Answer,:,,Symptomatic,disease,means,neurologic,worsening,in,he,form,of,episodic,attacks,or,slow,progressio
n.
The,most,common,presentations,are,as,follows:
Sensory,disturbance,such,as,numbness,,paresthesias,,pain,,or,Lhermitte's,sign,(21%,to,55%,of,patients)
