CNS: multiple sclerosis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · CNS: multiple sclerosis

Sample item

A 28-year-old woman has had optic neuritis followed by an internuclear ophthalmoplegia. MRI shows ovoid periventricular white matter lesions. What is the pathological hallmark of an active plaque?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Perivenular inflammation with loss of myelin and relative axonal preservation

Multiple sclerosis is an immune-mediated demyelinating disease of the central nervous system, in which T cells and macrophages attack myelin around venules. Plaques show loss of myelin and oligodendrocytes with relatively preserved axons, then astrocytic gliosis. CSF commonly has oligoclonal IgG bands.

Option by option

  • A. Primary axonal degeneration with intact myelin sheaths

    Primary axonal loss with preserved myelin is not the feature of MS plaques.

  • B. Vacuolation of the neuropil without any inflammation

    Vacuolation without inflammation describes prion disease.

  • C. Perivenular inflammation with loss of myelin and relative axonal preservation (correct)

    Correct. Perivenular inflammatory demyelination with relative axonal sparing defines the active plaque.

  • D. Demyelination of single peripheral nerve segments with onion bulbs

    Segmental demyelination with onion bulbs describes chronic inflammatory demyelinating polyneuropathy in peripheral nerves.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Perivenular inflammation with loss of myelin and relative axonal preservation. Multiple sclerosis is an immune-mediated demyelinating disease of the central nervous system, in which T cells and macrophages attack myelin around venules.

Why is "Primary axonal degeneration with intact myelin sheaths" not the answer?

Primary axonal loss with preserved myelin is not the feature of MS plaques.

Why is "Vacuolation of the neuropil without any inflammation" not the answer?

Vacuolation without inflammation describes prion disease.

Why is "Demyelination of single peripheral nerve segments with onion bulbs" not the answer?

Segmental demyelination with onion bulbs describes chronic inflammatory demyelinating polyneuropathy in peripheral nerves.

What concept does this question test?

It tests CNS: multiple sclerosis in Pathology. Plaques show loss of myelin and oligodendrocytes with relatively preserved axons, then astrocytic gliosis. CSF commonly has oligoclonal IgG bands.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study CNS: multiple sclerosis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.