Incorrect. The spinal roots are part of the PNS and are myelinated by Schwann cells. MS involves central myelin.
Correct! The spinal roots are part of the PNS and are myelinated by Schwann cells. MS involves central myelin.
Question 2: All MS follows a relapsing and exacerbating course
Incorrect. Some MS cases are progressive or do not have the classic remitting-exacerbating course.
Correct! Some MS cases are progressive or do not have the classic remitting-exacerbating course.
Question 3: Is remyelination in the central nervous system possible?
Incorrect. Oligodendrocytes are capable of producing new myelin and some plaques are partially remyelinated. However, the glial scar barrier prevents newly formed myelin sheath from reaching axons and, for the most part, remyelination is inefficient.
Correct! Oligodendrocytes are capable of producing new myelin and some plaques are partially remyelinated. However, the glial scar barrier prevents newly formed myelin sheath from reaching axons and, for the most part, remyelination is inefficient.
Question 4: Axons are not damaged in multiple sclerosis
Incorrect. Axonal damage occurs in MS, especially during the acute inflammatory period. Such damage may be severe and accounts for the permanent deficits in MS.
Correct! Axonal damage occurs in MS, especially during the acute inflammatory period. Such damage may be severe and accounts for the permanent deficits in MS.
Question 5: MS is more common in northern countries
Correct! MS is more common in northern countries.
Incorrect. MS is more common in northern countries.
Question 6: Which of the following is useful for treating MS?
Correct! INF Beta is useful for treating MS.
Incorrect. INF Beta is useful for treating MS, not INF Gamma.
Question 7: A 32 year old woman developed acute neurologic deficits and contrast enhancing periventricular lesions. A stereotactic biopsy revealed changes shown below. Immunohistochemistry of this lesion will show:
Incorrect. Perivascular lymphocytic infiltrates, probably mostly T-cells, consistent with MS.
Correct! Perivascular lymphocytic infiltrates, probably mostly T-cells, consistent with MS.
Incorrect. Perivascular lymphocytic infiltrates, probably mostly T-cells, consistent with MS.
Question 8: Conduction velocity in the peroneal nerve of a patient with MS and paraparesis is:
Incorrect. The peroneal nerve is PNS and is not affected by MS.
Incorrect. The peroneal nerve is PNS and is not affected by MS.
Correct! The peroneal nerve is PNS and is not affected by MS.
Incorrect. The peroneal nerve is PNS and is not affected by MS.
Question 9: The risk of MS in an identical twin of a patient with MS is:
Incorrect. Monozygotic twins are 30 to 50% concordant for MS; dizygotic twins are only 2.3% concordant.
Incorrect. Monozygotic twins are 30 to 50% concordant for MS; dizygotic twins are only 2.3% concordant.
Incorrect. Monozygotic twins are 30 to 50% concordant for MS; dizygotic twins are only 2.3% concordant.
Correct! Monozygotic twins are 30 to 50% concordant for MS; dizygotic twins are only 2.3% concordant.
Question 10: Which of the following is not seen in old MS lesions?
Incorrect. Inflammation is a feature of the acute phase of MS.
Incorrect. Inflammation is a feature of the acute phase of MS.
Incorrect. Inflammation is a feature of the acute phase of MS.
Correct! Inflammation is a feature of the acute phase of MS.
Question 11: Which of the statements regarding NMSOD is correct?
Incorrect. NMSOD may cause the area postrema syndrome (intractable vomiting unresponsive to antiemetics and hiccups).
Incorrect. NMSOD may cause the area postrema syndrome (intractable vomiting unresponsive to antiemetics and hiccups).
Incorrect. NMSOD may cause the area postrema syndrome (intractable vomiting unresponsive to antiemetics and hiccups).
Correct! NMSOD may cause the area postrema syndrome (intractable vomiting unresponsive to antiemetics and hiccups).
Question 12: Devic's disease is characterized by involvement mainly of:
Incorrect. Devic's disease (neuromyelitis optica) involves the optic nerves and the spinal cord. There may also be brainstem lesions in the floor of the 4th ventricle.
Incorrect. Devic's disease (neuromyelitis optica) involves the optic nerves and the spinal cord. There may also be brainstem lesions in the floor of the 4th ventricle.
Incorrect. Devic's disease (neuromyelitis optica) involves the optic nerves and the spinal cord. There may also be brainstem lesions in the floor of the 4th ventricle.
Incorrect. Devic's disease (neuromyelitis optica) involves the optic nerves and the spinal cord. There may also be brainstem lesions in the floor of the 4th ventricle.
Correct! Devic's disease (neuromyelitis optica) involves the optic nerves and the spinal cord. There may also be brainstem lesions in the floor of the 4th ventricle.
Question 13: Which of the following is most commonly affected in MS?
Incorrect. Periventricular white matter is most commonly affected in MS.
Incorrect. Periventricular white matter is most commonly affected in MS.
Correct! Periventricular white matter is most commonly affected in MS.
Incorrect. Periventricular white matter is most commonly affected in MS.
Question 14: A 37 year old man had progressive neurologic deficits including hemiparesis and ataxia for nine months. CSF shows 37 lymphocytes, protein 54, glucose 50, and no oligoclonal bands. The most likely diagnosis is:
Incorrect. The clinical picture and CSF formula are most consistent with MS. Oligoclonal bands are not present in all MS cases.
Incorrect. The clinical picture and CSF formula are most consistent with MS. Oligoclonal bands are not present in all MS cases.
Correct! The clinical picture and CSF formula are most consistent with MS. Oligoclonal bands are not present in all MS cases.
Incorrect. The clinical picture and CSF formula are most consistent with MS. Oligoclonal bands are not present in all MS cases.
Question 15: A 12 year old white male had progressive psychomotor decline for three years and the MRI findings shown below. The CSF shows 15 lymphocytes, glucose 67, protein 43, and normal CSF IgG/albumin ratio. The most likely diagnosis is:
Incorrect. The MRI images show bilateral symmetric demyelination, most severe in the occipital lobes. The most likely diagnosis with this clinical profile, imaging findings, and CSF profile is X-linked adrenoleukodystrophy.
Correct! The MRI images show bilateral symmetric demyelination, most severe in the occipital lobes. The most likely diagnosis with this clinical profile, imaging findings, and CSF profile is X-linked adrenoleukodystrophy.
Incorrect. The MRI images show bilateral symmetric demyelination, most severe in the occipital lobes. The most likely diagnosis with this clinical profile, imaging findings, and CSF profile is X-linked adrenoleukodystrophy.
Incorrect. The MRI images show bilateral symmetric demyelination, most severe in the occipital lobes. The most likely diagnosis with this clinical profile, imaging findings, and CSF profile is X-linked adrenoleukodystrophy.
Question 16: A 37 year old man with AIDS developed ataxia and paralysis. The MRI shows cerebellar and brainstem nonenhancing lesions. The cerebellar biopsy includes mostly normal cerebellar cortex and a small amount of white matter which shows a few mononuclear cells, macrophages and reactive astrocytes. The best way to obtain a diagnosis is:
Incorrect. Assuming that the most likely diagnosis is PML, PCR is probably the best way to go. IHC may be another good option.
Correct! Assuming that the most likely diagnosis is PML, PCR is probably the best way to go. IHC may be another good option.
Incorrect. Assuming that the most likely diagnosis is PML, PCR is probably the best way to go. IHC may be another good option.
Incorrect. Assuming that the most likely diagnosis is PML, PCR is probably the best way to go. IHC may be another good option.
Question 17: Which of the following structures is most commonly affected in MS?
Incorrect. The optic chiasm is most commonly affected in MS.
Incorrect. The optic chiasm is most commonly affected in MS.
Correct! The optic chiasm is most commonly affected in MS.
Incorrect. The optic chiasm is most commonly affected in MS.
Question 18: A 26 year old woman developed severe dizziness, hoarseness, extension of the neck, and right arm weakness in the course of 8 days. The MRI shows enhancing lesions in the lower brainstem and upper spinal cord. A stereotactic biopsy is shown below. The most likely diagnosis is:
Incorrect. The left part of the picture shows relatively normal myelin. The right two-thirds show pallor of myelin, consistent with demyelination, and perivascular lymphocytic infiltrates. The pathology is consistent with ADEM. Acute MS is another possibility.
Incorrect. The left part of the picture shows relatively normal myelin. The right two-thirds show pallor of myelin, consistent with demyelination, and perivascular lymphocytic infiltrates. The pathology is consistent with ADEM. Acute MS is another possibility.
Correct! The left part of the picture shows relatively normal myelin. The right two-thirds show pallor of myelin, consistent with demyelination, and perivascular lymphocytic infiltrates. The pathology is consistent with ADEM. Acute MS is another possibility.
Incorrect. The left part of the picture shows relatively normal myelin. The right two-thirds show pallor of myelin, consistent with demyelination, and perivascular lymphocytic infiltrates. The pathology is consistent with ADEM. Acute MS is another possibility.
Question 19: The pathology illustrated in this myelin stained section of the pons is likely to occur in all of the following conditions except:
Incorrect. The lesion is central pontine myelinolysis and is seen in all listed conditions except vitamin B1 deficiency.
Incorrect. The lesion is central pontine myelinolysis and is seen in all listed conditions except vitamin B1 deficiency.
Incorrect. The lesion is central pontine myelinolysis and is seen in all listed conditions except vitamin B1 deficiency.
Correct! The lesion is central pontine myelinolysis and is seen in all listed conditions except vitamin B1 deficiency.
Incorrect. The lesion is central pontine myelinolysis and is seen in all listed conditions except vitamin B1 deficiency.
Question 20: Stereotactic brain biopsy of a ring enhancing lesion of the left frontal lobe in a previously healthy 37 year old woman who had neurological symptoms for 2 months. Work up showed no fever, sinusitis or other findings. The most likely diagnosis is:
Correct! Perivascular lymphocytes and vacuolization of the white matter, consistent with MS. MS lesions may have a ring enhancing pattern radiologically. The mononuclear cells are small lymphocytes, not consistent with lymphoma. The absence of fever, sinusitis, or other findings rules out abscess and viral encephalitis.
Incorrect. Perivascular lymphocytes and vacuolization of the white matter, consistent with MS. MS lesions may have a ring enhancing pattern radiologically. The mononuclear cells are small lymphocytes, not consistent with lymphoma. The absence of fever, sinusitis, or other findings rules out abscess and viral encephalitis.
Incorrect. Perivascular lymphocytes and vacuolization of the white matter, consistent with MS. MS lesions may have a ring enhancing pattern radiologically. The mononuclear cells are small lymphocytes, not consistent with lymphoma. The absence of fever, sinusitis, or other findings rules out abscess and viral encephalitis.
Incorrect. Perivascular lymphocytes and vacuolization of the white matter, consistent with MS. MS lesions may have a ring enhancing pattern radiologically. The mononuclear cells are small lymphocytes, not consistent with lymphoma. The absence of fever, sinusitis, or other findings rules out abscess and viral encephalitis.
Question 21: The pathology in a 17 year old male shown below represents:
Incorrect. Bilateral loss of myelin in the occipital lobes in a 17-year old male is most consistent with x-linked adrenoleukodystrophy, a peroxisomal disorder. XALD is demyelinative and inflammatory but the primary defect is metabolic.
Correct! Bilateral loss of myelin in the occipital lobes in a 17-year old male is most consistent with x-linked adrenoleukodystrophy, a peroxisomal disorder. XALD is demyelinative and inflammatory but the primary defect is metabolic.
Incorrect. Bilateral loss of myelin in the occipital lobes in a 17-year old male is most consistent with x-linked adrenoleukodystrophy, a peroxisomal disorder. XALD is demyelinative and inflammatory but the primary defect is metabolic.
Incorrect. Bilateral loss of myelin in the occipital lobes in a 17-year old male is most consistent with x-linked adrenoleukodystrophy, a peroxisomal disorder. XALD is demyelinative and inflammatory but the primary defect is metabolic.
Question 22: Which entity can be specifically diagnosed by detecting antibodies to aquaporin?
Incorrect. Neuromyelitis optica can be specifically diagnosed by detecting antibodies to aquaporin (AQP-4).
Correct! Neuromyelitis optica can be specifically diagnosed by detecting antibodies to aquaporin (AQP-4).
Incorrect. Neuromyelitis optica can be specifically diagnosed by detecting antibodies to aquaporin (AQP-4).
Incorrect. Neuromyelitis optica can be specifically diagnosed
by detecting antibodies to aquaporin (AQP-4).
Question 23: * A 32 year old hemophiliac patient developed neurologic deficits and enhancing cerebral and cerebellar white matter lesions. The most likely diagnosis is:
Correct. The most likely diagnosis is PML in the
background of AIDS. The photomicrograph shows atypical astrocytes that
are seen in PML. This change probably reflects a productive infection of
astrocytes by papova viruses which are oncogenic viruses.
Incorrect. The most likely diagnosis is PML
in the background of AIDS. The photomicrograph
shows atypical astrocytes that are seen in PML. This change probably
reflects a productive infection of astrocytes by papova viruses which are oncogenic viruses.
Incorrect. The most likely diagnosis is PML
in the background of AIDS. The photomicrograph shows atypical
astrocytes that are seen in PML. This change probably reflects a
productive infection of astrocytes by papova viruses which are oncogenic viruses.
Incorrect. The most likely diagnosis is PML in the
background of AIDS. The photomicrograph shows atypical astrocytes that
are seen in PML. This change probably reflects a productive infection of
astrocytes by papova viruses which are oncogenic viruses.
