[MCQ] Multiple Sclerosis and Other Demyelinating Diseases- Part 2

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Multiple Sclerosis and Other Demyelinating Diseases- Part 2

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Question 1

Which of the following does not favour the diagnosis of MS ?

A	Mild CSF pleocytosis (> 5 cells/μL)
B	CSF protein concentration of > 100 mg/dL
C	Lesions in the anterior corpus callosum
D	Dawson’s fingers

Question 1 Explanation:

Pleocytosis of >75 cells/μL, presence of polymorphonuclear leukocytes, or a protein concentration of >100 mg/dL in CSF should raise doubts about MS. Lesions in the anterior corpus callosum are frequent in MS and rare in vascular disease. Dawson’s fingers refers to lesions as seen in MRI that are oriented perpendicular to ventricular surface, and corresponding to pathologic pattern of perivenous demyelination.

Question 2

Which of the following is a marker of axonal integrity ?

A	Propionyl-CoA carboxylase
B	Argininosuccinate lyase
C	N-acetyl aspartate
D	N-Acetylglutamate synthase

Question 2 Explanation:

N-acetyl aspartate, which is a marker of axonal integrity. Proton magnetic resonance spectroscopic imaging (MRSI) can quantitate it.

Question 3

Which of the following is uncommon in MS ?

A	Aphasia
B	Seizures
C	Chorea
D	All of the above

Question 3 Explanation:

Uncommon or rare symptoms in MS are aphasia, parkinsonism, chorea, isolated dementia, severe muscular atrophy, peripheral neuropathy, episodic loss of consciousness, fever, headache, seizures, or coma.

Question 4

Disorders that can mimic multiple sclerosis are all except ?

A	Vitamin B12 deficiency
B	Syphilis
C	Sarcoid
D	HSV-1 encephalitis

Question 4 Explanation:

Disorders that can mimic multiple sclerosis are acute disseminated encephalomyelitis (ADEM), Antiphospholipid antibody syndrome (APLA), Behçet’s disease, Cerebral autosomal dominant arteriopathy, subcortical infarcts, and leukoencephalopathy (CADASIL), Congenital leukodystrophies (adrenoleukodystrophy, metachromatic leukodystrophy), HIV infection, Ischemic optic neuropathy, Lyme disease, Mitochondrial encephalopathy with lactic acidosis and stroke (MELAS), Neoplasms (lymphoma, glioma, meningioma), Sarcoid, Sjögren’s syndrome, Stroke & ischemic cerebrovascular disease, Syphilis, Systemic lupus erythematosus, Tropical spastic paraparesis (HTLV I/II infection), Vascular malformations, Vasculitis, Vitamin B12 deficiency.

Question 5

Clinical features that have a more favorable prognosis in MS include all except ?

A	Optic neuritis or sensory symptoms at onset
B	Pyramidal symptoms
C	Women
D	Age < 40 years at onset

Question 5 Explanation:

Clinical features that point towards favorable prognosis in MS are ON or sensory symptoms at onset, <2 relapses in 1st year of illness & minimal impairment after 5 years. Those with truncal ataxia, action tremor, pyramidal symptoms or progressive disease are likely to be disabled.

Question 6

Likelihood of having benign MS is about ?

A	2 %
B	5 %
C	10 %
D	20 %

Question 6 Explanation:

In benign variant of MS, patients never develop neurologic disability & maintain a benign course. Likelihood of having benign MS is <20%.

Question 7

Kurtzke Expanded Disability Status Score (EDSS) is used for ?

A	Parkinson disease
B	Multiple sclerosis
C	Alzheimer’s disease
D	Creutzfeldt-Jakob disease

Question 8

Most patients with Kurtzke Expanded Disability Status Score (EDSS) scores < 3.5 have ?

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

Question 8 Explanation:

Kurtzke Expanded Disability Status Score (EDSS) is a measure of neurologic impairment in MS. Most patients with EDSS scores <3.5 have RRMS and are generally not disabled. Patients with EDSS scores >5.5 have progressive MS (SPMS or PPMS), are gait-impaired and occupationally disabled.

Question 9

Which of the following is used for acute attacks of MS ?

A	Glucocorticoids
B	Mitoxantrone
C	Glatiramer acetate
D	All of the above

Question 9 Explanation:

Glucocorticoids are used to manage first attacks or acute exacerbations of MS.

Question 10

Disease modifying therapies for RRMS include ?

A	IFN β1a
B	Mitoxantrone (MTX)
C	Glatiramer acetate (GA)
D	All of the above

Question 10 Explanation:

Disease-Modifying Therapies for Relapsing Forms of MS (RRMS, SPMS with Exacerbations) include IFN--1a, IFN--1b, glatiramer acetate & natalizumab, fingolimod, and mitoxantrone. Cladribine awaits FDA approval.

Question 11

Which of the following drugs is used for patients with progressive disability in MS ?

A	Glucocorticoid
B	Plasma exchange
C	Mitoxantrone
D	Glatiramer acetate

Question 11 Explanation:

Mitoxantrone is an immune suppressant generally reserved for patients with progressive disability who have failed other treatments. Mitoxantrone should not be used as a first-line agent in either RRMS or relapsing SPMS.

Question 12

Untreated patients of MS should be followed with ?

A	Objective clinical CNS examination
B	Evoked Potential testing
C	Kurtzke Expanded Disability Status Score (EDSS)
D	Periodic brain MRI scans

Question 12 Explanation:

Untreated patients are followed closely with periodic brain MRI scans.

Question 13

Which of the following is the first-line therapy for Relapsing/ remitting MS ?

A	IFN β
B	IV Ig
C	Mitoxantrone
D	Natalizumab

Question 13 Explanation:

Relapsing forms of MS are treated with IFN- or glatiramer acetate as first-line therapy

Question 14

Which of the following is administered by IV infusion ?

A	IFN-β-1a
B	IFN-β-1b
C	Glatiramer acetate
D	Natalizumab

Question 14 Explanation:

IFN--1a (IM), IFN--1b (SC), Glatiramer acetate (SC), Natalizumab (IV infusion).

Question 15

Which of the following is administered orally ?

A	IFN-β-1a
B	Mitoxantrone
C	Glatiramer acetate
D	Fingolimod

Question 16

Mitoxantrone is indicated for use in ?

A	SPMS
B	PRMS
C	Worsening RRMS
D	All of the above

Question 16 Explanation:

Mitoxantrone is indicated in SPMS, PRMS, and worsening RRMS.

Question 17

Worsening RRMS is defined as ?

A	Neurologic status abnormal between MS attacks
B	Worsening CSF IgG index
C	MRI lesions >3 mm in diameter
D	Involvment of more sites of CNS

Question 17 Explanation:

Worsening RRMS is defined as patients whose neurologic status remains significantly abnormal between MS attacks.

Question 18

Which of the following therapies is effective in treating PPMS ?

A	Glucocorticoids
B	IFNβ1a
C	Glatiramer acetate
D	None of the above

Question 18 Explanation:

No currently available therapies have shown any promise for treating PPMS at this time.

Question 19

Devic’s syndrome refers to which of the following ?

A	Acute Disseminated Encephalomyelitis (ADEM)
B	Isolated dementia
C	Neuromyelitis optica (NMO)
D	Mitochondrial encephalopathy

Question 19 Explanation:

Neuromyelitis optica (NMO) is also called Devic’s syndrome.

Question 20

In neuromyelitis optica, which of the following is involved ?

A	Brainstem
B	Cerebellum
C	Cognitive functions
D	None of the above

Question 20 Explanation:

In contrast to MS, patients with NMO do not experience brainstem, cerebellar & cognitive involvement, & the brain MRI is typically normal. Over three or more spinal cord segments are involved.

Question 21

Autoantibody against which of the following is seen in neuromyelitis optica ?

A	Aquaporin-1
B	Aquaporin-2
C	Aquaporin-3
D	Aquaporin-4

Question 21 Explanation:

A highly specific autoantibody directed against water channel protein aquaporin-4 is seen in >50% patients of NMO. Aquaporin-4 is localized to foot processes of astrocytes in close apposition to endothelial surfaces.

Question 22

In Marburg’s variant of multiple sclerosis, the course of disease is ?

A	Hyperacute
B	Subacute
C	Fulminant
D	Chronic

Question 22 Explanation:

Acute MS (Marburg’s variant) is a fulminant demyelinating process that in some cases progresses inexorably to death within 1–2 years.

Question 23

Which of the following about multiple sclerosis is false ?

A	Plaque is a chronic inflammatory, demyelinating lesion
B	Plaque lesions develop in white matter
C	Primary targets are myelin sheath & oligodendrocyte
D	Gray matter lesions are known to occur

Question 24

Which of the following about acute lesions of multiple sclerosis is false ?

A	Indistinct margin, hypercellularity, intense perivascular infiltration, loss of myelin and oligodendrocytes
B	Widespread axonal damage, plasma cells, myelin-laden macrophages
C	Hypertrophic astrocytes
D	Astroglial scarring

Question 25

Most explosive form of acute disseminated encephalomyelitis (ADEM) is called ?

A	Mitochondrial encephalopathy
B	Acute hemorrhagic leukoencephalitis
C	Tropical spastic paraparesis
D	Metachromatic leukodystrophy

Question 25 Explanation:

Acute hemorrhagic leukoencephalitis is the most explosive form of ADEM. Lesions are vasculitic & hemorrhagic & the clinical course is devastating.

Question 26

Which of the following is false about acute disseminated encephalomyelitis (ADEM) ?

A	Polyphasic course
B	Postvaccinal encephalomyelitis
C	Postinfectious encephalomyelitis
D	Perivenular inflammation & demyelination

Question 26 Explanation:

ADEM has a monophasic course & is associated with antecedent immunization (postvaccinal encephalomyelitis) or infection (postinfectious encephalo-myelitis). Hallmark of ADEM is presence of widely scattered small foci of perivenular inflammation & demyelination

Question 27

ADEM can follow infections with all except ?

A	Measles
B	Varicella
C	Mycoplasma
D	Legionella

Question 28

ADEM can follow infections with all except ?

A	Rubella
B	Hepatitis B
C	Mumps
D	Infectious mononucleosis virus

Question 29

Which CNS antigens correlates with development of ADEM ?

A	Vascular cell adhesion molecule (VCAM)
B	Myelin basic protein (MBP)
C	Bruton’s tyrosine kinase (BTK)
D	Stromal-cell derived factor (SDF)

Question 29 Explanation:

All forms of ADEM result from a cross-reactive immune response to infectious agent or vaccine that triggers an inflammatory demyelinating response. Autoantibodies to MBP and to other myelin antigens have been detected in the CSF from many patients with ADEM.

Question 30

Cerebellar involvement in ADEM is common in infections due to ?

A	Measles
B	Varicella
C	Mycoplasma
D	Mumps

Question 30 Explanation:

In ADEM due to chickenpox, cerebellar involvement is often conspicuous.

Question 31

ADEM is differentiated from MS by ?

A	Simultaneous onset of disseminated symptoms & signs
B	Drowsiness or coma
C	Seizures
D	All of the above

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See all quizzes of Multiple Sclerosis and Other Demyelinating Diseases- Part 2 System here:

1 Which of the following does not favour the diagnosis of MS ?
A. Mild CSF pleocytosis (> 5 cells/μL)
B. CSF protein concentration of > 100 mg/dL
C. Lesions in the anterior corpus callosum
D. Dawson’s fingers

2 Which of the following is a marker of axonal integrity ?
A. Propionyl-CoA carboxylase
B. Argininosuccinate lyase
C. N-acetyl aspartate
D. N-Acetylglutamate synthase

3 Which of the following is uncommon in MS ?
A. Aphasia
B. Seizures
C. Chorea
D. All of the above

4 Disorders that can mimic multiple sclerosis are all except ?
A. Vitamin B12 deficiency
B. Syphilis
C. Sarcoid
D. HSV-1 encephalitis

5 Clinical features that have a more favorable prognosis in MS
include all except ?
A. Optic neuritis or sensory symptoms at onset
B. Pyramidal symptoms
C. Women
D. Age < 40 years at onset

6 Likelihood of having benign MS is about ?
A. 2 %
B. 5 %
C. 10 %
D. 20 %

7 Kurtzke Expanded Disability Status Score (EDSS) is used for ?
A. Parkinson disease
B. Multiple sclerosis
C. Alzheimer’s disease
D. Creutzfeldt-Jakob disease
8 Most patients with Kurtzke Expanded Disability Status Score
(EDSS) scores < 3.5 have ?
A. Relapsing/remitting MS (RRMS)
B. Secondary progressive MS (SPMS)
C. Primary progressive MS (PPMS)
D. Progressive/relapsing MS (PRMS)

9 Which of the following is used for acute attacks of MS ?
A. Glucocorticoids
B. Mitoxantrone
C. Glatiramer acetate
D. All of the above

10 Disease modifying therapies for RRMS include ?
A. IFN 1a
B. Mitoxantrone (MTX)
C. Glatiramer acetate (GA)
D. All of the above

11 Which of the following drugs is used for patients with progressive
disability in MS ?
A. Glucocorticoid
B. Plasma exchange
C. Mitoxantrone
D. Glatiramer acetate

12 Untreated patients of MS should be followed with ?
A. Objective clinical CNS examination
B. Evoked Potential testing
C. Kurtzke Expanded Disability Status Score (EDSS)
D. Periodic brain MRI scans

13 Which of the following is the first-line therapy for Relapsing/
remitting MS ?
A. IFN 
B. IV Ig
C. Mitoxantrone
D. Natalizumab

14 Which of the following is administered by IV infusion ?
A. IFN--1a
B. IFN--1b
C. Glatiramer acetate
D. Natalizumab

15 Which of the following is administered orally ?
A. IFN--1a
B. Mitoxantrone
C. Glatiramer acetate
D. Fingolimod
16 Mitoxantrone is indicated for use in ?
A. SPMS
B. PRMS
C. Worsening RRMS
D. All of the above

17 Worsening RRMS is defined as ?
A. Neurologic status abnormal between MS attacks
B. Worsening CSF IgG index
C. MRI lesions >3 mm in diameter
D. Involvment of more sites of CNS

17 Which of the following therapies is effective in treating PPMS ?
A. Glucocorticoids
B. IFN 1a
C. Glatiramer acetate
D. None of the above

18 Devic’s syndrome refers to which of the following ?
A. Acute Disseminated Encephalomyelitis (ADEM)
B. Isolated dementia
C. Neuromyelitis optica (NMO)
D. Mitochondrial encephalopathy

19 In neuromyelitis optica, which of the following is involved ?
A. Brainstem
B. Cerebellum
C. Cognitive functions
D. None of the above

20 Autoantibody against which of the following is seen in
neuromyelitis optica ?
A. Aquaporin-1
B. Aquaporin-2
C. Aquaporin-3
D. Aquaporin-4

21 In Marburg’s variant of multiple sclerosis, the course of disease
is ?
A. Hyperacute
B. Subacute
C. Fulminant
D. Chronic

22 Which of the following about multiple sclerosis is false ?
A. Plaque is a chronic inflammatory, demyelinating lesion
B. Plaque lesions develop in white matter
C. Primary targets are myelin sheath & oligodendrocyte
D. Gray matter lesions are known to occur
23 Which of the following about acute lesions of multiple sclerosis
is false ?
A. Indistinct margin, hypercellularity, intense perivascular
infiltration, loss of myelin and oligodendrocytes
B. Widespread axonal damage, plasma cells, myelin-laden
macrophages
C. Hypertrophic astrocytes
D. Astroglial scarring
24 Most explosive form of acute disseminated encephalomyelitis
(ADEM) is called ?
A. Mitochondrial encephalopathy
B Acute hemorrhagic leukoencephalitis
C. Tropical spastic paraparesis
D. Metachromatic leukodystrophy

27 Which of the following is false about acute disseminated
encephalomyelitis (ADEM) ?
A. Polyphasic course
B. Postvaccinal encephalomyelitis
C. Postinfectious encephalomyelitis
D. Perivenular inflammation & demyelination

28 ADEM can follow infections with all except ?
A. Measles
B. Varicella
C. Mycoplasma
D. Legionella
29 ADEM can follow infections with all except ?
A. Rubella
B. Hepatitis B
C. Mumps
D. Infectious mononucleosis virus

30 Which CNS antigens correlates with development of ADEM ?
A. Vascular cell adhesion molecule (VCAM)
B. Myelin basic protein (MBP)
C. Bruton’s tyrosine kinase (BTK)
D. Stromal-cell derived factor (SDF)

31 Cerebellar involvement in ADEM is common in infections due to ?
A. Measles
B. Varicella
C. Mycoplasma
D. Mumps

32 ADEM is differentiated from MS by ?
A. Simultaneous onset of disseminated symptoms & signs
B. Drowsiness or coma
C. Seizures
D. All of the above
33 ADEM is differentiated from MS by ?
A. Bilateral involvement of optic nerve
B. Complete transverse myelopathy
C. Monophasic course
D. All of the above

Multiple Sclerosis and Other Demyelinating Diseases

[MCQ] Multiple Sclerosis and Other Demyelinating Diseases- Part 2

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Multiple Sclerosis and Other Demyelinating Diseases- Part 2

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