FastTest. You ve read the book now test yourself

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1 FastTest You ve read the book now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. The answers will refer you back to relevant sections of the book to address any areas of uncertainty. Which of the following statements are correct? Note: there may be more than one correct answer per question.

2 1 Epidemiology and genetics 1. Which of the following statement(s) about multiple sclerosis (MS) is/are correct? a) MS is more prevalent in temperate than equatorial regions b) The prevalence of MS peaks at age 30 c) The rate of MS is higher in smokers than those who have never smoked d) Individuals with MS are often seropositive for Epstein Barr virus e) Populations exposed to limited sunlight but who consume diets rich in fatty fish have lower MS prevalence rates than expected f) MS is more common in men than women g) Risk of MS rises with increasing genetic proximity to an affected individual

3 2 Pathology 2. In the pathogenesis of MS: a) only the white matter tends to be affected in chronic disease b) the sudden appearance of large numbers of activiated microglia and macrophages is the hallmark of acute disease c) demyelination of axons usually takes up to 8 weeks d) remyelinating oligodendrocytes appear within days of an episode of acute inflammatory demyelination

4 3 The clinical picture 3. Risk factors for progression from relapsing remitting MS to secondary progressive disease include: a) younger age at disease onset b) a long interval between the first and second relapses c) a high, and increasing, T2 lesion load d) a motor deficit with incomplete recovery

5 4. The spectrum of signs and symptoms of MS is broad. a) Most (approximately 9 in 10) of new lesions in the hemispheric deep white matter are symptomatic b) Internuclear ophthalmoplegia is a characteristic sign of MS, but it is often asymptomatic c) Cognitive impairment can begin in the early relapsing phase of the disease in some patients d) L hermitte s sign is pathognomonic for MS

6 5. MRI is the most important investigation in the diagnosis and monitoring of MS. a) White matter lesions and active inflammation are best visualized on T2-weighted images b) The number of asymptomatic demyelinating lesions on MRI in an individual with clinically isolated syndrome can be used to predict the likelihood of developing clinically definite MS c) Most new lesions exhibit gadolinium enhancement for 2 6 weeks d) Spinal cord lesions are usually centrally located

7 6. Red flag features that suggest a differential diagnosis for MS include: a) loss of visual acuity or color vision b) history of a preceding systemic infection or immunization c) gradual onset of neurological symptoms d) atypical findings on MRI such as hemorrhage

8 4 Treatment of relapses and symptoms 7 Corticosteroid therapy: a) is the mainstay of treatment for MS relapses b) shortens relapse duration c) improves functional outcome d) should be given to all symptomatic MS patients

9 8 Which of the following statement(s) is/are correct? a) Baclofen is the most common first-line treatment for spasticity b) Anticholinergic therapy is the primary treatment strategy in patients with significant post-voiding residual volume of urine (> 100 ml) c) Tricyclic antidepressants are the primary therapy for trigeminal neuralgia d) Both seizures and paroxysmal symptoms respond rapidly to anticonvulsant therapy

10 5 Disease-modifying treatment 9. In patients with relapsing MS, disease-modifying treatment: a) reduces the rate of relapse b) slows the rate of lesion accumulation on MRI c) reduces disability d) slows the progression of the disease in the long term

11 10. Conventional therapy (interferon beta-1a and -1b and glatiramer acetate): a) is injected intramuscularly on a weekly basis b) requires regular liver function monitoring c) has been shown to delay a second clinical attack by up to 12 months in people who have had a clinically isolated syndrome d) should be discontinued and the patient escalated to second-line therapy if progressive disease is indicated

12 11. New generation therapy a) Patients receiving natalizumab should have 6-monthly brain MRIs to monitor for progressive multifocal leukoencephalopathy b) Patients receiving fingolimod are at increased risk of infection with herpes simplex and varicella zoster virus c) Natalizumab and fingolimod are oral treatments d) A treatment strategy that starts with well-tolerated conventional DMT and escalates to new generation agents is appropriate in patients with mild to moderate relapsing disease

13 6 Emerging therapies 12. Which of the following statement(s) is/are correct? a) Alemtuzumab (a monoclonal antibody) is a potential new first-line treatment for patients with remitting relapsing MS b) The monoclonal antibody rituximab is being investigated in MS populations c) Laquinimod is a new intravenous therapy in development d) Dramatic MRI responses to autologous hematopoietic stem cell transplantation have been reported

14 7 Special MS populations 13. MS before, during and after pregnancy. a) MS has a detrimental effect on fertility b) Relapse rates are often reduced during pregnancy c) Pregnancy has been shown to speed up disease progression in some women d) Disease-modifying treatments are generally not recommended during breast-feeding

15 14. MS in children and the elderly. a) Children usually first present with MS with multiple symptoms b) In children, MS can only be reliably distinguished from acute disseminated encephalomyelitis (ADEM) by MRI c) Accumulation of disability is slower in children with MS than in adults d) Comorbidities in the elderly affect treatment choice

16 8 Lifestyle considerations and the multidisciplinary team 15. Patients should be advised: a) to avoid live-attenuated vaccinations if they are receiving immunosuppressive therapy b) to plan all pregnancies c) that anesthetics may trigger exacerbations of the disease d) to go on a special diet high in fat and protein

17 9 Advanced multiple sclerosis 16. Which of the following statement(s) is/are correct? a) Disease onset at a younger age is associated with longer survival b) Secondary progression occurs in up to 75% of patients with relapsing remitting disease c) Early introduction of disease-modifying treatment may positively affect long-term mortality d) None of the above

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