N352 Exam 3 Questions and Correct Answers
Normal Immune Response
- virus or foreign body (antigen) enters the body
- lymphocytes (B and T lymphocytes) will start rescue action
- B lymphocytes produce antibodies and can directly bind to antigens right on the surface of
the invading virus or bacteria
- T lymphocytes have two types:
- Killer T cells: directly attack pathogens
- Helper T cells: release cytokines which alert B cells to multiply and produce more
antibodies
Autoimmunity
B and T cells mistakenly attack a person's "own cells"
The immune system can not differentiate "self from non-self"
Immune cells that are normally unresponsive (tolerant to self antigens) get activated due to
some unknown reason
Multiple Sclerosis
A progressive immune-related demyelination disorder of the CNS
Frequently, the disease is relapsing and remitting; has exacerbations and recurrences of
symptoms
Disease of young to middle aged adults
Peak onset b/w 25-35 years
Women are affected 2-3 times more often than men
More prevalent in temperate climates (away from equator)
,o Northern united states, Canada & Europe
May have genetic predisposition
Environmental risk factors:
o Smoking
o Lack of vitamin D exposure
o Exposure to the Epstein-Barr virus
MS Pathophysiology
T&B lymphocytes attack the cells of the CNS (brain and spinal cord) ->
leads to inflammation which leads to demyelination (myelin = insulating layer of the neurons
which speeds up the conduction of impulses along the nerve cells) ->
demyelination leads to impaired transmission of nerve impulses due to destruction of myelin
sheath ->
results in a variety of manifestations depending on what nerves are affected ->
demyelinated nerves are scattered irregularly throughout CNS
Most frequently affected areas are optic nerves, cerebrum, brain stem, cerebellum and spinal
cord
The axons will begin to degenerate resulting in permanent & irreversible damage
Types and Courses of MS
1. Relapsing-remitting (85% of cases): acute attacks with full recovery or with sequelae and
residual deficit upon recovery. Periods b/w disease relapses are characterized by lack of
disease progression
2. Primary-progressive (10%): progression of disease without plateaus or temporary minor
improvements
3. Secondary-progressive: A relapsing-remitting initial course, followed by progression with
,or without occasional relapses, minor remissions & plateaus
4. Progressive-relapsing (5%): Progressive disease from onset, but with clear acute relapses
with or without recovery
MS Symptoms
Fatigue (common disabling symptom)
Depression
Weakness
Difficulty in coordination, loss of balance
Sensory symptoms (numbness, tingling, chronic neuropathic pain d/t lesions)
Cognitive changes: memory loss; decreased concentration
Visual disturbances: lesions in the optic nerve (nystagmus, blurred vision, diplopia, patchy
blindness & total blindness)
Cerebellum: ataxia - impaired coordination and movement
Motor symptoms:
- Weakness or paralysis of the limbs
- Speech: scanning speech
- Intentional tremors
- Spasticity (stiff muscles; d/t involvement of the motor pathways in the spinal cord)
Digestive system : Constipation
Urinary system = Neurogenic bladder (both spastic (incontinence) & flaccid (retention)
, Lhermitte's Sign: flexed neck leads to sudden sensation of electric shock down spine &along
arms
Lhermitte's sign
Patient seated or supine, patient actively/passively flexes head toward chest.
Positive sign is sharp electric shock like sensation down the spine into the extremities
indicating multiple sclerosis, myelopathy, or other demyelinating cord lesions
Disparities in Symptom Presentation in MS
African Americans & Hispanics: Problem with eyes & pain
Whites: More numbness & tingling
MS Diagnosis
MRI (gold standard) - high sensitivity of detecting demyelinating plaques
History and physical examination
CSF analysis (Increased immunoglobulin G & Increased Lymphocytes)
CT scan
MS Management (Goals)
no cure for MS
Goals of treatment:
- delay the progression of the disease (disease modifying therapies)
- manage chronic symptoms (Bladder dysfunction, Depression, Fatigue, Spasticity)
- treat acute exacerbations
Normal Immune Response
- virus or foreign body (antigen) enters the body
- lymphocytes (B and T lymphocytes) will start rescue action
- B lymphocytes produce antibodies and can directly bind to antigens right on the surface of
the invading virus or bacteria
- T lymphocytes have two types:
- Killer T cells: directly attack pathogens
- Helper T cells: release cytokines which alert B cells to multiply and produce more
antibodies
Autoimmunity
B and T cells mistakenly attack a person's "own cells"
The immune system can not differentiate "self from non-self"
Immune cells that are normally unresponsive (tolerant to self antigens) get activated due to
some unknown reason
Multiple Sclerosis
A progressive immune-related demyelination disorder of the CNS
Frequently, the disease is relapsing and remitting; has exacerbations and recurrences of
symptoms
Disease of young to middle aged adults
Peak onset b/w 25-35 years
Women are affected 2-3 times more often than men
More prevalent in temperate climates (away from equator)
,o Northern united states, Canada & Europe
May have genetic predisposition
Environmental risk factors:
o Smoking
o Lack of vitamin D exposure
o Exposure to the Epstein-Barr virus
MS Pathophysiology
T&B lymphocytes attack the cells of the CNS (brain and spinal cord) ->
leads to inflammation which leads to demyelination (myelin = insulating layer of the neurons
which speeds up the conduction of impulses along the nerve cells) ->
demyelination leads to impaired transmission of nerve impulses due to destruction of myelin
sheath ->
results in a variety of manifestations depending on what nerves are affected ->
demyelinated nerves are scattered irregularly throughout CNS
Most frequently affected areas are optic nerves, cerebrum, brain stem, cerebellum and spinal
cord
The axons will begin to degenerate resulting in permanent & irreversible damage
Types and Courses of MS
1. Relapsing-remitting (85% of cases): acute attacks with full recovery or with sequelae and
residual deficit upon recovery. Periods b/w disease relapses are characterized by lack of
disease progression
2. Primary-progressive (10%): progression of disease without plateaus or temporary minor
improvements
3. Secondary-progressive: A relapsing-remitting initial course, followed by progression with
,or without occasional relapses, minor remissions & plateaus
4. Progressive-relapsing (5%): Progressive disease from onset, but with clear acute relapses
with or without recovery
MS Symptoms
Fatigue (common disabling symptom)
Depression
Weakness
Difficulty in coordination, loss of balance
Sensory symptoms (numbness, tingling, chronic neuropathic pain d/t lesions)
Cognitive changes: memory loss; decreased concentration
Visual disturbances: lesions in the optic nerve (nystagmus, blurred vision, diplopia, patchy
blindness & total blindness)
Cerebellum: ataxia - impaired coordination and movement
Motor symptoms:
- Weakness or paralysis of the limbs
- Speech: scanning speech
- Intentional tremors
- Spasticity (stiff muscles; d/t involvement of the motor pathways in the spinal cord)
Digestive system : Constipation
Urinary system = Neurogenic bladder (both spastic (incontinence) & flaccid (retention)
, Lhermitte's Sign: flexed neck leads to sudden sensation of electric shock down spine &along
arms
Lhermitte's sign
Patient seated or supine, patient actively/passively flexes head toward chest.
Positive sign is sharp electric shock like sensation down the spine into the extremities
indicating multiple sclerosis, myelopathy, or other demyelinating cord lesions
Disparities in Symptom Presentation in MS
African Americans & Hispanics: Problem with eyes & pain
Whites: More numbness & tingling
MS Diagnosis
MRI (gold standard) - high sensitivity of detecting demyelinating plaques
History and physical examination
CSF analysis (Increased immunoglobulin G & Increased Lymphocytes)
CT scan
MS Management (Goals)
no cure for MS
Goals of treatment:
- delay the progression of the disease (disease modifying therapies)
- manage chronic symptoms (Bladder dysfunction, Depression, Fatigue, Spasticity)
- treat acute exacerbations
