ADVANCED PATHOPHYSIOLOGY FINAL EXAM NEWEST
2024 ACTUAL EXAM 75 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
Do women or men more often have multiple sclerosis? - ANSWER: 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 - ANSWER: Multiple Sclerosis
What is the main pathophysiological theory for multiple sclerosis? - ANSWER: It's an
autoimmune/neurodegenerative disease:
-inflammation
-demyelination/remyelination
-permanent axonal damage
What are the Myelin forming cells of the CNS? - ANSWER: Oligodendrocytes
What do T-Helper cell types 1 & 17 do? - ANSWER: Pro-inflammatory
What does T-Helper cell type 2 do? - ANSWER: Anti-inflammatory
What is the pathophysiology of Multple Sclerosis? - ANSWER: 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 - ANSWER: Multiple Sclerosis
Which cognitive test is most commonly used to diagnose MS? - ANSWER: Symbol
Digit Modalities Test (SDMT)
What is the primary diagnostic test for MS? - ANSWER: 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? - ANSWER:
Relapsing 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? -
ANSWER: 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? -
ANSWER: 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 - ANSWER: 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 - ANSWER: Bad prognosis
What are the treatment goals for treating MS? - ANSWER: -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 ___________. - ANSWER: 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? - ANSWER: 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? - ANSWER: 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? - ANSWER: Temporal lobe
Which lobe of the brain is responsible for sensations (touch, feeling pain, spacial
representation)? - ANSWER: Parietal lobe
Which part of the brain is responsible for planning, abstract thinking, organizing,
reward system, pleasure? - ANSWER: Frontal Lobe
Which part of the brain is responsible for vision? - ANSWER: Occipital lobe
Which part of the brain is responsible for voluntary movement (face, neck, trunk,
upper/lower extremities)? - ANSWER: Motor Cortex
Which part of the brain is responsible for sensations of tingling, numbness, touch,
smell of burnt rubber, parasthesisas? - ANSWER: 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? - ANSWER: Broca's: speech
Wernicke's: formation of thought/words
, Which part of the brain is responsible for hearing? - ANSWER: Auditory Cortex
Which part of the brain is responsible for sensory information processing, perceptual
disturbances? - ANSWER: Association Cortex
When does Epilepsy most often present in patients? - ANSWER: Most often in
infancy and childhood
What are the International League Against Epilepsy (ILAE) Epilepsy etiologies? -
ANSWER: 1. Genetic
2. Structural
3. Infectious
4. Metabolic
5. Immune
6. Unknown
What is the pathophysiology of Seizures? - ANSWER: 1. Excessive excitation of
cortical neurons (hyperexcitable/hypersynchronization)
-Abnormal functioning of Na/K pump, ligand-activated channels, voltage-gated
channels.
-Abnormal ATPase functioning
-Abnormal synaptic vesicle protein 2-A
-Changes in receptors, second messaging systems
2. Disorder inhibition of cortical neurons
3. Transitory imbalance in neurotransmitters
-Enhanced excitatory neurotransmission (Glutamate/Aspartate, and NMDA/AMPA
receptors)
What are some seizure recurrence risk factors? - ANSWER: -Abnormal EEG
-Seizure occurs during sleep
-Family history
-Prior acute seizure
-Mental retardation or cerebral palsy
*NOT seizure type
*NOT seizure length
*NOT age of onset
What type of seizure involves one hemisphere of the brain and may be with or
without dyscognitive features. - ANSWER: Focal Seizures
What type of seizure involves the loss of consciousness for 5-20 seconds but the
patient does not lose postural control? - ANSWER: Absence Seizure
2024 ACTUAL EXAM 75 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS) |ALREADY GRADED A+
Do women or men more often have multiple sclerosis? - ANSWER: 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 - ANSWER: Multiple Sclerosis
What is the main pathophysiological theory for multiple sclerosis? - ANSWER: It's an
autoimmune/neurodegenerative disease:
-inflammation
-demyelination/remyelination
-permanent axonal damage
What are the Myelin forming cells of the CNS? - ANSWER: Oligodendrocytes
What do T-Helper cell types 1 & 17 do? - ANSWER: Pro-inflammatory
What does T-Helper cell type 2 do? - ANSWER: Anti-inflammatory
What is the pathophysiology of Multple Sclerosis? - ANSWER: 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 - ANSWER: Multiple Sclerosis
Which cognitive test is most commonly used to diagnose MS? - ANSWER: Symbol
Digit Modalities Test (SDMT)
What is the primary diagnostic test for MS? - ANSWER: 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? - ANSWER:
Relapsing 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? -
ANSWER: 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? -
ANSWER: 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 - ANSWER: 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 - ANSWER: Bad prognosis
What are the treatment goals for treating MS? - ANSWER: -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 ___________. - ANSWER: 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? - ANSWER: 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? - ANSWER: 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? - ANSWER: Temporal lobe
Which lobe of the brain is responsible for sensations (touch, feeling pain, spacial
representation)? - ANSWER: Parietal lobe
Which part of the brain is responsible for planning, abstract thinking, organizing,
reward system, pleasure? - ANSWER: Frontal Lobe
Which part of the brain is responsible for vision? - ANSWER: Occipital lobe
Which part of the brain is responsible for voluntary movement (face, neck, trunk,
upper/lower extremities)? - ANSWER: Motor Cortex
Which part of the brain is responsible for sensations of tingling, numbness, touch,
smell of burnt rubber, parasthesisas? - ANSWER: 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? - ANSWER: Broca's: speech
Wernicke's: formation of thought/words
, Which part of the brain is responsible for hearing? - ANSWER: Auditory Cortex
Which part of the brain is responsible for sensory information processing, perceptual
disturbances? - ANSWER: Association Cortex
When does Epilepsy most often present in patients? - ANSWER: Most often in
infancy and childhood
What are the International League Against Epilepsy (ILAE) Epilepsy etiologies? -
ANSWER: 1. Genetic
2. Structural
3. Infectious
4. Metabolic
5. Immune
6. Unknown
What is the pathophysiology of Seizures? - ANSWER: 1. Excessive excitation of
cortical neurons (hyperexcitable/hypersynchronization)
-Abnormal functioning of Na/K pump, ligand-activated channels, voltage-gated
channels.
-Abnormal ATPase functioning
-Abnormal synaptic vesicle protein 2-A
-Changes in receptors, second messaging systems
2. Disorder inhibition of cortical neurons
3. Transitory imbalance in neurotransmitters
-Enhanced excitatory neurotransmission (Glutamate/Aspartate, and NMDA/AMPA
receptors)
What are some seizure recurrence risk factors? - ANSWER: -Abnormal EEG
-Seizure occurs during sleep
-Family history
-Prior acute seizure
-Mental retardation or cerebral palsy
*NOT seizure type
*NOT seizure length
*NOT age of onset
What type of seizure involves one hemisphere of the brain and may be with or
without dyscognitive features. - ANSWER: Focal Seizures
What type of seizure involves the loss of consciousness for 5-20 seconds but the
patient does not lose postural control? - ANSWER: Absence Seizure
