[MCQ] Multiple Sclerosis and Other Demyelinating Diseases- Part 1

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Multiple Sclerosis and Other Demyelinating Diseases- Part 1

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Congratulations - you have completed Multiple Sclerosis and Other Demyelinating Diseases- Part 1. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Which of the following is false about demyelinating disorders ?

A	Immune-mediated preferential destruction of CNS myelin
B	Peripheral nervous system (PNS) is spared
C	No evidence of associated systemic illness
D	None of the above

Question 1 Explanation:

Demyelinating disorders are immune-mediated conditions characterized by preferential destruction of central nervous system (CNS) myelin. The peripheral nervous system (PNS) is spared, and most patients have no evidence of an associated systemic illness.

Question 2

Triad in multiple sclerosis (MS) includes all except ?

A	Inflammation
B	Demyelination
C	Remyelination
D	Gliosis

Question 2 Explanation:

Multiple sclerosis is characterized by a triad of inflammation, demyelination, and gliosis (scarring) with neuronal loss specially in advanced cases. Relative sparing of axons is typical of MS. Lesions of MS typically occur at different times and in different CNS locations (i.e., disseminated in time and space).

Question 3

New MS lesions begin with ?

A	Astrocytic proliferation
B	Disruption of blood-brain barrier (BBB)
C	Perivenular cuffing by inflammatory mononuclear cells
D	Infiltration of nervous system by B lymphocytes

Question 3 Explanation:

New MS lesions begin with perivenular cuffing by inflammatory mononuclear cells, predominantly T cells and macrophages.

Question 4

“Shadow plaques” refer to ?

A	Astrocytic proliferation (gliotic areas)
B	Remyelination of surviving naked axons
C	Aggregates of T and B cells
D	Any of the above

Question 4 Explanation:

Surviving oligodendrocytes partially remyelinate surviving naked axons, producing “shadow plaques”.

Question 5

Nerve conduction in myelinated axons occurs in a saltatory manner at a velocity of ?

A	~ 50 meters / second
B	~ 70 meters / second
C	~ 90 meters / second
D	~ 110 meters / second

Question 5 Explanation:

Nerve conduction in myelinated axons occurs in saltatory manner at a velocity of ~70 m/sec. In unmyelinated nerves, continuous propagation occurs at ~1 m/sec.

Question 6

Which of the following is best related to pathophysiology of MS ?

A	Redistribution of potassium channels along naked axon
B	Redistribution of sodium channels along naked axon
C	Redistribution of calcium channels along naked axon
D	Redistribution of chloride channels along naked axon

Question 6 Explanation:

In MS, due to demyelination, conduction blocks occur. Axons that are normally buried underneath the myelin sheath are exposed. Thereafter, resting axon membrane becomes hyperpolarized due to exposure of voltage-dependent potassium channels. Sodium channels are concentrated at the nodes of Ranvier. With demyelination sodium channels redistribute along the naked axon allowing slow, rather than saltatory, continuous propagation of nerve action potentials through the demyelinated segment.

Question 7

Risk of developing MS is highest ?

A	If an identical twin has MS
B	If a sibling has MS
C	If a parent has MS
D	If a spouse has MS

Question 7 Explanation:

Risk of developing MS is highest if an identical twin has MS (1 in 3).

Question 8

Which of the following is false about multiple sclerosis ?

A	Thrice more common in women than men
B	Age of onset is between 20 and 40 years
C	Prevalence decreases at higher latitudes
D	~10% cases begin <18 years of age

Question 8 Explanation:

Prevalence rates of MS increase at higher latitudes.

Question 9

Highest known prevalence for MS is in ?

A	Middle east
B	Orkney Islands
C	Tasmania
D	Fiji

Question 9 Explanation:

Highest known prevalence for MS is in Orkney Islands (Scotland) (250 per 100,000).

Question 10

Deficiency of which of the following vitamins is associated with an increase in MS risk ?

A	A
B	D
C	E
D	C

Question 10 Explanation:

Vitamin D deficiency is associated with an increase in MS risk. Ongoing deficiency may increase the relapse rate in established MS.

Question 11

In northern hemisphere, babies born in which month are significantly more likely to develop MS ?

A	February
B	May
C	September
D	December

Question 11 Explanation:

In northern hemisphere, babies born in May are significantly more likely to develop MS than those born in November. This is called “month-of-birth effect”. Opposite is true for southern hemisphere

Question 12

Which of the following races are inherently at higher risk for MS ?

A	Whites
B	Africans
C	Asians
D	All of the above

Question 12 Explanation:

Whites are inherently at higher risk for MS than Africans or Asians.

Question 13

Which of the following is the strongest MS susceptibility region in the genome ?

A	MHC on chromosome 6
B	MHC on chromosome 7
C	MHC on chromosome 8
D	MHC on chromosome 9

Question 13 Explanation:

Major histocompatibility complex (MHC) on chromosome 6 is by far the strongest MS susceptibility region in the genome.

Question 14

Which virus produces demyelinating disease having lesions resembling lesions of MS ?

A	Theiler virus
B	Varicella
C	Rubella
D	Epstein-Barr

Question 15

Which out of the following is the most common initial symptoms of MS ?

A	Paresthesias
B	Diplopia
C	Ataxia
D	Vertigo

Question 16

Which out of the following is the most common initial symptoms of MS ?

A	Sensory loss
B	Diplopia
C	Optic neuritis
D	Bladder dysfunction

Question 17

Which of the following is characteristic of MS ?

A	Movement-induced muscle spasms
B	Exercise-induced weakness of limbs
C	Monocular visual loss
D	Acquired pendular nystagmus

Question 17 Explanation:

Exercise-induced weakness of limbs is characteristic of MS. Weakness is of UMN type accompanied by spasticity, hyperreflexia & Babinski signs.

Question 18

Which of the following is strongly suggestive of MS ?

A	Horizontal gaze palsy
B	Bilateral internuclear ophthalmoplegia (INO)
C	“One and a half” syndrome
D	Acquired pendular nystagmus

Question 18 Explanation:

Bilateral internuclear ophthalmoplegia (INO) is particularly suggestive of MS. Other gaze disturbances include horizontal gaze palsy, “one and a half” syndrome (horizontal gaze palsy + an INO) & acquired pendular nystagmus.

Question 19

In MS, optic neuritis (ON) is least likely to presents as ?

A	Diminished visual acuity
B	Dimness
C	Decreased color perception
D	Complete loss of light perception

Question 19 Explanation:

Optic neuritis (ON) presents as diminished visual acuity, dimness, or decreased color perception (desaturation) in the central field of vision. Rarely, there is complete loss of light perception.

Question 20

In MS, which of the following statements is false ?

A	Visual symptoms are generally bilateral
B	Periorbital pain precedes or accompanies visual loss
C	Afferent pupillary defect is usually present
D	Uveitis is uncommon

Question 20 Explanation:

Visual symptoms are generally monocular but may be bilateral. Periorbital pain often precedes or accompanies visual loss. Afferent pupillary defect is usually present. Funduscopic examination may be normal or reveal optic disc swelling (papillitis). Pallor of optic disc (optic atrophy) commonly follows ON. Uveitis is uncommon.

Question 21

Symptoms of bladder dysfunction are present in what percentage of MS patients ?

A	50 %
B	65 %
C	75 %
D	90 %

Question 21 Explanation:

Bladder dysfunction is present in >90% of MS patients.

Question 22

Which of the following about sensory symptoms in MS is false ?

A	Paresthesias
B	Hypesthesia
C	Sensory level
D	None of the above

Question 22 Explanation:

Sensory symptoms in MS include paresthesias, hypesthesia, unpleasant sensations, bandlike sensation of tightness around torso.

Question 23

Ataxia in MS usually manifests as ?

A	Cerebellar tremors
B	Hyperthyroid tremors
C	Episodic ataxia
D	Gait apraxia

Question 23 Explanation:

Ataxia usually manifests as cerebellar tremors

Question 24

Which of the following was once thought to be characteristic of MS ?

A	Euphoria
B	Impaired attention
C	Memory loss
D	Slowed information processing

Question 24 Explanation:

Euphoria (elevated mood) was once thought to be characteristic of MS but is actually uncommon, occurring in <20% of patients.

Question 25

In MS, fatigue can be exacerbated by ?

A	Elevated temperatures
B	Depression
C	Sleep disturbances
D	All of the above

Question 25 Explanation:

90% of patients of MS experience fatigue which is exacerbated by elevated temperatures, depression, or sleep disturbances.

Question 26

In MS, facial weakness is characterised by ?

A	Resembles idiopathic Bell’s palsy
B	Not associated with ipsilateral loss of taste sensation
C	Not associated with retroauricular pain
D	All of the above

Question 26 Explanation:

Facial weakness due to a MS lesion in pons resembles idiopathic Bell’s palsy but is not associated with ipsilateral loss of taste or retroauricular pain.

Question 27

In MS, ‘Uhthoff’s symptom’ is related to ?

A	Facial myokymia
B	Visual symptoms
C	Heat sensitivity
D	Movement

Question 27 Explanation:

Heat sensitivity refers to neurologic symptoms produced by elevation of body’s core temperature. Unilateral visual blurring may occur during a hot shower or with physical exercise (Uhthoff’s symptom).

Question 28

Which of the following is false about Lhermitte’s symptom ?

A	Electric shock - like sensation
B	Evoked by neck flexion
C	Radiates down the back into legs
D	None of the above

Question 28 Explanation:

Lhermitte’s symptom is an electric shock like sensation, typically induced by flexion of neck, that radiates down the back into legs. Lhermitte’s symptom can also occur with other disorders of cervical spinal cord (cervical spondylosis). Vitamin B12 deficiency syndrome and Cisplatin toxicity can also cause it.

Question 29

At onset, which of the following is the commonest clinical type of MS ?

A	Relapsing/remitting MS (RRMS)
B	Secondary progressive MS (SPMS)
C	Primary progressive MS (PPMS)
D	Progressive/relapsing MS (PRMS)

Question 29 Explanation:

Relapsing/remitting MS (RRMS) accounts for 85% of MS cases at onset.

Question 30

Secondary progressive MS (SPMS) always begins as ?

A	Relapsing/remitting MS (RRMS)
B	Primary progressive MS (PPMS)
C	Progressive/relapsing MS (PRMS)
D	Any of the above

Question 30 Explanation:

Secondary progressive MS (SPMS) always begins as RRMS.

Question 31

Which of the following clinical type of MS has a more favorable prognosis ?

A	Relapsing/remitting MS (RRMS)
B	Secondary progressive MS (SPMS)
C	Primary progressive MS (PPMS)
D	Progressive/relapsing MS (PRMS)

Question 31 Explanation:

Relapsing/remitting MS (RRMS) is characterized by discrete attacks that evolve over days to weeks with complete recovery over weeks to months. Between attacks, patients are neurologically stable.

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See all quizzes of Multiple Sclerosis and Other Demyelinating Diseases- Part 1 System here:

1. Which of the following is false about demyelinating disorders ?
A. Immune-mediated preferential destruction of CNS myelin
B. Peripheral nervous system (PNS) is spared
C. No evidence of associated systemic illness
D. None of the above

2. Triad in multiple sclerosis (MS) includes all except ?
A. Inflammation
B. Demyelination
C. Remyelination
D. Gliosis

3. New MS lesions begin with ?
A. Astrocytic proliferation
B. Disruption of blood-brain barrier (BBB)
C. Perivenular cuffing by inflammatory mononuclear cells
D. Infiltration of nervous system by B lymphocytes

4. “Shadow plaques” refer to ?
A. Astrocytic proliferation (gliotic areas)
B. Remyelination of surviving naked axons
C. Aggregates of T and B cells
D. Any of the above
5.Nerve conduction in myelinated axons occurs in a saltatory manner
at a velocity of ?
A. ~ 50 meters / second
B. ~ 70 meters / second
C. ~ 90 meters / second
D. ~ 110 meters / second

6. Which of the following is best related to pathophysiology of MS ?
A. Redistribution of potassium channels along naked axon
B. Redistribution of sodium channels along naked axon
C. Redistribution of calcium channels along naked axon
D. Redistribution of chloride channels along naked axon

7. Risk of developing MS is highest ?
A. If an identical twin has MS
B. If a sibling has MS
C. If a parent has MS
D. If a spouse has MS

8. Which of the following is false about multiple sclerosis ?
A. Thrice more common in women than men
B. Age of onset is between 20 and 40 years
C. Prevalence decreases at higher latitudes
D. ~10% cases begin <18 years of age
Prevalence rates of MS increase at higher latitudes.
9. Highest known prevalence for MS is in ?
A. Middle east
B. Orkney Islands
C. Tasmania
D. Fiji

10.Deficiency of which of the following vitamins is associated with
an increase in MS risk ?
A. A
B. D
C. E
D. C

11. In northern hemisphere, babies born in which month are
significantly more likely to develop MS ?
A. February
B. May
C. September
D. December

12. Which of the following races are inherently at higher risk for MS ?
A. Whites
B. Africans
C. Asians
D. All of the above

13. Which of the following is the strongest MS susceptibility region
in the genome ?
A. MHC on chromosome 6
B. MHC on chromosome 7
C. MHC on chromosome 8
D. MHC on chromosome 9

14. Which virus produces demyelinating disease having lesions
resembling lesions of MS ?
A. Theiler virus
B. Varicella
C. Rubella
D. Epstein-Barr
15. Which out of the following is the most common initial symptoms
of MS ?
A. Paresthesias
B. Diplopia
C. Ataxia
D. Vertigo
16. Which out of the following is the most common initial symptoms
of MS ?
A. Sensory loss
B. Diplopia
C. Optic neuritis
D. Bladder dysfunction
17. Which of the following is characteristic of MS ?
A. Movement-induced muscle spasms
B. Exercise-induced weakness of limbs
C. Monocular visual loss
D. Acquired pendular nystagmus

18. Which of the following is strongly suggestive of MS ?
A. Horizontal gaze palsy
B. Bilateral internuclear ophthalmoplegia (INO)
C. “One and a half” syndrome
D. Acquired pendular nystagmus

19. In MS, optic neuritis (ON) is least likely to presents as ?
A. Diminished visual acuity
B. Dimness
C. Decreased color perception
D. Complete loss of light perception

20.In MS, which of the following statements is false ?
A. Visual symptoms are generally bilateral
B. Periorbital pain precedes or accompanies visual loss
C. Afferent pupillary defect is usually present
D. Uveitis is uncommon

21. Symptoms of bladder dysfunction are present in what percentage
of MS patients ?
A. 50 %
B. 65 %
C. 75 %
D. 90 %

22. Which of the following about sensory symptoms in MS is false ?
A. Paresthesias
B. Hypesthesia
C. Sensory level
D. None of the above

23. Ataxia in MS usually manifests as ?
A. Cerebellar tremors
B. Hyperthyroid tremors
C. Episodic ataxia
D. Gait apraxia

24.Which of the following was once thought to be characteristic of
MS ?
A. Euphoria
B. Impaired attention
C. Memory loss
D. Slowed information processing

25. In MS, fatigue can be exacerbated by ?
A. Elevated temperatures
B. Depression
C. Sleep disturbances
D. All of the above

26. In MS, facial weakness is characterised by ?
A. Resembles idiopathic Bell’s palsy
B. Not associated with ipsilateral loss of taste sensation
C. Not associated with retroauricular pain
D. All of the above

27. In MS, ‘Uhthoff’s symptom’ is related to ?
A. Facial myokymia
B. Visual symptoms
C. Heat sensitivity
D. Movement

28. Which of the following is false about Lhermitte’s symptom ?
A. Electric shock – like sensation
B. Evoked by neck flexion
C. Radiates down the back into legs
D. None of the above

29. At onset, which of the following is the commonest clinical type of
MS ?
A. Relapsing/remitting MS (RRMS)
B. Secondary progressive MS (SPMS)
C. Primary progressive MS (PPMS)
D. Progressive/relapsing MS (PRMS)

30. Secondary progressive MS (SPMS) always begins as ?
A. Relapsing/remitting MS (RRMS)
B. Primary progressive MS (PPMS)
C. Progressive/relapsing MS (PRMS)
D. Any of the above

31. Which of the following clinical type of MS has a more favorable
prognosis ?
A. Relapsing/remitting MS (RRMS)
B. Secondary progressive MS (SPMS)
C. Primary progressive MS (PPMS)
D. Progressive/relapsing MS (PRMS)

Multiple Sclerosis and Other Demyelinating Diseases

[MCQ] Multiple Sclerosis and Other Demyelinating Diseases- Part 1

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Multiple Sclerosis and Other Demyelinating Diseases- Part 1

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