1. A 58-year-old woman with relapsing MS has been clinically and radiographically stable for 6 years on a high-efficacy anti-CD20 therapy. She has developed recurrent infections and mild hypogammaglobulinemia and is interested in switching to a lower-risk oral therapy for convenience. MRI shows no gadolinium-enhancing lesions or new T2 lesions. Which of the following is the most appropriate next step?
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Continue current therapy without change given stable disease
Switch directly to a moderate-efficacy DMT without monitoring
Consider de-escalation with immune monitoring and close MRI surveillance
Discontinue DMT completely without monitoring due to advancing age
Switch to natalizumab due to infection risk on anti-CD20 therapy
2. A 28-year-old man is diagnosed with relapsing MS after presenting with two disabling relapses in 6 months and multiple gadolinium-enhancing lesions on MRI. He has no comorbidities and is highly motivated for effective disease control. What is the most appropriate treatment strategy?
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Start with low-efficacy injectable therapy and escalate only after further disease activity (e.g., relapses or new MRI lesions)
Initiate high-efficacy disease-modifying therapy early
Delay treatment until further diagnostic confirmation over time
Treat only symptomatically and monitor MRI annually
Begin therapy only after documented disability accrual on EDSS
3. Which of the following emerging therapies target B cells?
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Fenebrutinib
Remibrutinib
Obexilimab
Frexalimab
All of the above
4. Which one of the following is not a function of BTK inhibitors?
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Modulation of microglia function
Target immature B cells
Reduce autoantibody production
Alter T cell activation
Decrease pro-inflammatory cytokine release
5. Which of the following oral disease modifying therapies can cause or worsen macular edema?
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Dimethyl fumarate
Cladribine
Fingolimod
Teriflunomide
6. Which of the following immunization recommendations should be considered with use of anti CD20 medications?
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Initiation of an anti CD20 medication should be delayed until all recommended vaccines are completed.
Live-attenuated vaccines should be administered at least 4 weeks prior to initiation of anti CD20 medications.
Inactivated vaccines can be given at any time before anti CD20 therapy initiation.
Vaccines are contraindicated in individuals who are taking anti CD20 medications.
7. Spasticity management in MS may include:
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Heavy weightlifting
Intense cardio activity
Significant Hydration
Avoiding physical activity
8. What is the prevalence of cognitive impairment in clinically isolated syndrome?
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10%
20%
30%
40%
50%
9. What is the most effective form of treatment for cognitive dysfunction in people with MS?
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Cognitive Rehabilitation
Cognitive Behavior Therapy
High Efficacy Disease Modifying Therapy
Moderate Efficacy Disease Modifying Therapy
Cognitive compensatory training
10. Which of the following best reflects a comprehensive approach to wellness in individuals living with multiple sclerosis?
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Focusing primarily on pharmacologic treatment to reduce disease activity
Prioritizing physical activity over nutrition and sleep
Integrating physical activity, nutrition, stress management, sleep, and social engagement
Avoiding exercise to prevent symptom exacerbation
11. Which of the following is true about symptom management in persons with advanced disability from multiple sclerosis (MS)?
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There is no role for physicians in de-prescribing medications.
Spasticity is always problematic in persons with MS.
Randomized controlled trials provide strong evidence that all persons with MS benefit from intensive rehabilitation.
Persons with advanced MS can benefit from dedicated appointment(s) to address their symptoms, not just their disease.
12. Which of the following DMTs need to be stopped in advance of trying to conceive?
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Fingolimod
Ocrelizumab
Ofatumumab
All of the above
None of the above
13. Which of the following DMTs are not compatible with lactation?
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Ocrelizumab
Ofatumumab
Glatiramer acetate
Cladribine
A, B and D
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