Advanced Pathophysiology Exam 3 –
Comprehensive Practice Questions,
Clinical Concepts, and Exam Preparation
Guide
Do women or men more often have multiple Women (2-3:1)
sclerosis?
Which disease has the following risk factors: Multiple Sclerosis
-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
What is the main pathophysiological theory It's an autoimmune/neurodegenerative disease:
for multiple sclerosis? -inflammation
-demyelination/remyelination
-permanent axonal damage
What are the Myelin forming cells of the Oligodendrocytes
CNS?
What do T-Helper cell types 1 & 17 do? Pro-inflammatory
What does T-Helper cell type 2 do? Anti-inflammatory
Which T cell types exhibit plasticity? T-Helper 17 & T-Regulatory
,What is the pathophysiology of Multple 1. Autoreactive T cells express Very Late Antegen-4
Sclerosis? (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.
In MS, autoreactive T cells express ____________ on Autoreactive T cells express Very Late Antegen-4 (VLA-4,
their cell surface and secrete_____________. aka α4-integrin) on their cell surface and secrete Matrix
Metalloproteinases (MMP).
In MS, VLA-4 binds to__________receptors on VLA-4 binds to Vascular Cell Adhesion Molecule (VCAM)
the blood brain barrier (BBB) and MMP receptors on the blood brain barrier (BBB) and MMP results in
results in dysregulation of the BBB, allowing dysregulation of the BBB, allowing cell entry into the CNS.
cell entry into the CNS.
In MS, once T cells enter the CNS, pro- Once in the CNS, pro-inflammatory cytokines (TNF-α, INF-γ,
inflammatory cytokines (__________,____, and Osteopontin [OP]) are secreted resulting in inflammation
and and further T cell entry into the CNS.
__________) are secreted resulting in
inflammation and further T cell entry into
the CNS.
In MS, T cells in the CNS interact with T cells in the CNS interact with microglia, astrocytes, and
__________, ___________, and_________________to macrophages to produce reactive oxygen species and nitric
produce reactive oxygen species and nitric oxide causing CNS damage.
oxide causing CNS damage.
In MS,______cells acts as ACPs, enter the B cells acts as ACPs, enter the CNS, and produce myelin-
CNS, and produce myelin-specific specific antibodies that form membrane attack
antibodies that form membrane attack complexes with complement causing cell lysis.
complexes with complement causing cell
lysis.
, Which disease presents in the following way: Multiple Sclerosis
**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
Which cognitive test is most commonly used Symbol Digit Modalities Test (SDMT)
to diagnose MS?
What is the primary diagnostic test for MS? MRI with or without contrast
The McDonald Criteria is used to diagnose Disseminated in time (DIT)
MS, and involves lesions disseminated in Disseminated in space (DIS)
________________ and______________.
What does the McDonald Criteria for One of the following:
diagnosing MS Disseminated in time (DIT) 1. Gadolinium-enhancing lesions (compared to baseline MRI).
require? 2. Simultaneous presence of Gadolinium-enhancing and non-
enhancing lesions.
The McDonald Criteria for diagnosing MS 1. Periventricular
Disseminated in space (DIS) requires the 2. Juxtacortical
presence of lesions in 2 out of what four 3. Infratentorial
areas? 4. Spinal cord
Which type of MS is were the patient has Radiographically Isolated Syndrome (RIS)
MRI features of MS, but does not meet the
DIS, and have no symptoms?
What is the most common type of MS, which Relapsing Remitting MS (RRMS)
is involves episodes of acute worsening with
some recovery and no progression in
between exacerbations?
What type of MS can develop from RRMS, Secondary Progressive MS (SPMS)
have a steady progression of the disease in
between exacerbations, and present with
more black holes and brain atrophy?
Comprehensive Practice Questions,
Clinical Concepts, and Exam Preparation
Guide
Do women or men more often have multiple Women (2-3:1)
sclerosis?
Which disease has the following risk factors: Multiple Sclerosis
-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
What is the main pathophysiological theory It's an autoimmune/neurodegenerative disease:
for multiple sclerosis? -inflammation
-demyelination/remyelination
-permanent axonal damage
What are the Myelin forming cells of the Oligodendrocytes
CNS?
What do T-Helper cell types 1 & 17 do? Pro-inflammatory
What does T-Helper cell type 2 do? Anti-inflammatory
Which T cell types exhibit plasticity? T-Helper 17 & T-Regulatory
,What is the pathophysiology of Multple 1. Autoreactive T cells express Very Late Antegen-4
Sclerosis? (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.
In MS, autoreactive T cells express ____________ on Autoreactive T cells express Very Late Antegen-4 (VLA-4,
their cell surface and secrete_____________. aka α4-integrin) on their cell surface and secrete Matrix
Metalloproteinases (MMP).
In MS, VLA-4 binds to__________receptors on VLA-4 binds to Vascular Cell Adhesion Molecule (VCAM)
the blood brain barrier (BBB) and MMP receptors on the blood brain barrier (BBB) and MMP results in
results in dysregulation of the BBB, allowing dysregulation of the BBB, allowing cell entry into the CNS.
cell entry into the CNS.
In MS, once T cells enter the CNS, pro- Once in the CNS, pro-inflammatory cytokines (TNF-α, INF-γ,
inflammatory cytokines (__________,____, and Osteopontin [OP]) are secreted resulting in inflammation
and and further T cell entry into the CNS.
__________) are secreted resulting in
inflammation and further T cell entry into
the CNS.
In MS, T cells in the CNS interact with T cells in the CNS interact with microglia, astrocytes, and
__________, ___________, and_________________to macrophages to produce reactive oxygen species and nitric
produce reactive oxygen species and nitric oxide causing CNS damage.
oxide causing CNS damage.
In MS,______cells acts as ACPs, enter the B cells acts as ACPs, enter the CNS, and produce myelin-
CNS, and produce myelin-specific specific antibodies that form membrane attack
antibodies that form membrane attack complexes with complement causing cell lysis.
complexes with complement causing cell
lysis.
, Which disease presents in the following way: Multiple Sclerosis
**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
Which cognitive test is most commonly used Symbol Digit Modalities Test (SDMT)
to diagnose MS?
What is the primary diagnostic test for MS? MRI with or without contrast
The McDonald Criteria is used to diagnose Disseminated in time (DIT)
MS, and involves lesions disseminated in Disseminated in space (DIS)
________________ and______________.
What does the McDonald Criteria for One of the following:
diagnosing MS Disseminated in time (DIT) 1. Gadolinium-enhancing lesions (compared to baseline MRI).
require? 2. Simultaneous presence of Gadolinium-enhancing and non-
enhancing lesions.
The McDonald Criteria for diagnosing MS 1. Periventricular
Disseminated in space (DIS) requires the 2. Juxtacortical
presence of lesions in 2 out of what four 3. Infratentorial
areas? 4. Spinal cord
Which type of MS is were the patient has Radiographically Isolated Syndrome (RIS)
MRI features of MS, but does not meet the
DIS, and have no symptoms?
What is the most common type of MS, which Relapsing Remitting MS (RRMS)
is involves episodes of acute worsening with
some recovery and no progression in
between exacerbations?
What type of MS can develop from RRMS, Secondary Progressive MS (SPMS)
have a steady progression of the disease in
between exacerbations, and present with
more black holes and brain atrophy?
