EXAM MN 551 ADVANCED PATHOPHYSIOLOGY FINAL EXAM QUESTIONS AND ANSWERS GRADE A+

EXAM MN 551 ADVANCED PATHOPHYSIOLOGY FINAL EXAM QUESTIONS AND ANSWERS GRADE A+ Do women or men more often have multiple sclerosis? - ANSWERS IS- Women (2-3:1) Which disease has the following risk factors: -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 - ANSWERS IS- Multiple Sclerosis What is the main pathophysiological theory for multiple sclerosis? - ANSWERS IS- It's an autoimmune/neurodegenerative disease: -inflammation -demyelination/remyelination -permanent axonal damage What are the Myelin forming cells of the CNS? - ANSWERS IS- Oligodendrocytes What do T-Helper cell types 1 & 17 do? - ANSWERS IS- Pro-inflammatory What does T-Helper cell type 2 do? - ANSWERS IS- Anti-inflammatory What is the pathophysiology of Multple Sclerosis? - ANSWERS IS- 1. Autoreactive T cells express Very Late Antegen-4 (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. Which disease presents in the following way: **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 - ANSWERS IS- Multiple Sclerosis Which cognitive test is most commonly used to diagnose MS? - ANSWERS IS- Symbol Digit Modalities Test (SDMT) What is the primary diagnostic test for MS? - ANSWERS IS- MRI with or without contrast What is the most common type of MS, which is involves episodes of acute worsening with some recovery and no progression in between exacerbations? - ANSWERS ISRelapsing Remitting MS (RRMS) What type of MS can develop from RRMS, have a steady progression of the disease in between exacerbations, and present with more black holes and brain atrophy? - ANSWERS IS- Secondary Progressive MS (SPMS) What type of MS is the least common, it doesn't develop from RRMS and is the progressive worsening of the disease from the start, lacking recovery times? - ANSWERS IS- Primary Progressive MS (PPMS) What is the prognosis (good or bad) for someone with MS who is: - under 40 years old -Female -First sign/symptom is optic neuritis/sensory issues -Low exacerbation frequency -RRMS -Single lesion - ANSWERS IS- Good prognosis What is the prognosis (good or bad) for someone with MS who is: - over 40 years old -Male -First sign/symptom is motor or cerebellar -Multiple lesion locations -PPMS - ANSWERS IS- Bad prognosis What are the treatment goals for treating MS? - ANSWERS IS- -Decrease attack/exacerbation rate -Decrease annualized relapse rate (ARR) -Slow progression of disease -Prevent/limit ADRs -Symptom management (fatigue, bladder dysfunction, cognitive dysfunction, constipation, depression) When monitoring MS patients should follow-up with their neurologists every _________. Get an MRI every ___________. - ANSWERS IS- When monitoring MS patients should follow-up with their neurologists every 6 months-1 year. Get an MRI every 1 year (based on need). What is the difference between seizure and epilepsy? - ANSWERS IS- Seizure: a discrete clinical event that results in the abnormal synchronous discharge of a set of neurons in the brain. Epilepsy: at least 2 unprovoked seizures occurring more than 24 hours apart. What is Status Epilepticus? - ANSWERS IS- Failure of the termination mechanisms for seizure leading to abnormally prolonged seizures. Length of seizure beyond 5 minutes and duration beyond the risk of long-term consequence (30 minutes). Which part of the brain is responsible for visual memory, organizing sensory information, emotional responses? - ANSWERS IS- Temporal lobe Which lobe of the brain is responsible for sensations (touch, feeling pain, spacial representation)? - ANSWERS IS- Parietal lobe Which part of the brain is responsible for planning, abstract thinking, organizing, reward system, pleasure? - ANSWERS IS- Frontal Lobe Which part of the brain is responsible for vision? - ANSWERS IS- Occipital lobe Which part of the brain is responsible for voluntary movement (face, neck, trunk, upper/lower extremities)? - ANSWERS IS- Motor Cortex Which part of the brain is responsible for sensations of tingling, numbness, touch, smell of burnt rubber, parasthesisas? - ANSWERS IS- Somatosensory Cortex Which part of the brain is responsible for speech? and which part is responsible for speech terms of the formation of thoughts and word? - ANSWERS IS- Broca's: speech Wernicke's: formation of thought/words