Neuroinfectious Diseases Exam 1

The building block of the nervous system is the neuron

True

The choroid plexus is located within the ventricles and contains the B-CSFB

True

The different brain barriers define compartments in the CNS that differ functionally in their communication with the immune system

True

As we age, the glymphatic system is not as efficient in removing wastes (and antigens), resulting in an impairment of the neuroimmune system by blocking the movement of T cells into the brain parenchyma

True

Lymph from anywhere in your body will at least be filtered by oe lymph node prior to return to the blood

True

Many substances act as neurotransmitters, including amino acids, gases, small organic chemicals, and short pepties

True

Microglia are the resident immune cells of the brain

True

Reflexes are rapid responses to stimuli that are possible because the brain is not involved in processing

True

The BBB is disrupted in many neurological disorders including MS, Guillain-Barre, and stroke

True

The CSF/ISF flow is the common link between the glymphatic and lymphatic systems

True

The location of the CNS lymphatics vessels (i.e. in the dura mater rather than in the brain parenchyma) may explain the evidence previously used to state the immune-privileged organ hypothesis

True

The lymphatic vessel are open ended and as such, can allow easy flow of large molecules and cells

True

The main functions of the lymphatic system are to prevent edema, regulate fluid pressure in tissues, and provide a path to immune cells to lymph nodes

True

There are nerve cells as long as half the length of your body

True

Under healthy conditions, there are almost no neutrophils and lymphocytes within the brain parenchyma

True

The CNS has 3 protective structures

bone, meninges, CSF

The properties of the BBB are mostly due to the microvascular endothelial cells, but are augmented and maintained by the action of which type of cells? A. Astrocytes, microglia, and pericytes B. Microglia, muscle cells, and perivascular macrophages C. Astrocytes, pericytes, and perivascular macrophages D. Ependymal cells, microglia, and pericytes

A. Astrocytes, microglia, and pericytes

Which of the following is a logical reason to study the choroid plexus? A. Because it is more permeable than the BBB, targeting drugs to the B-CSFB might be a viable way to get drugs to enter the brain B. To understand how the lymphatic system works in the brain C. To understand the anatomy of the brain D. To prevent passage of cells from outside the brain to the CSF

A. Because it is more permeable than the BBB, targeting drugs to the B-CSFB might be a viable way to get drugs to enter the brain

Under healthy conditions, T cells rarely cross into the brain parenchyma. When they do, they cross downstream BBB, in the postcapillary venules. Which of the following is the correct sequence of events? A. Cross the vascular endothelia, reactivation in perivascular space, cross the glia limitans B. Cross the vascular endothelia, cross the glia limitans, reactivation in the brain parenchyma C. Cross the glia limitans, reactivation in the blood, cross the vascular endothelia D. Cross the fenestrated vascular endothelia, reactivation in the perivascular space, cross the ependymal cell monolayer

A. Cross the vascular endothelia, reactivation in perivascular space, cross the glia limitans

Maturation of the choroid plexus exhibit what structural change? A. Formation of microvilli and cilia on the apical side of the ependymal cells B. Increase of the total number of endoplasmic reticula C. Polarization of the machinery and enzymes required for CSF secretion to the basolateral side D. Changes on the morphology of the ependymal cells from pseudostratified to cylindrical

A. Formation of microvilli and cilia on the apical side of the ependymal cells

Recent studies indicate that the cervical lymph nodes have access to antigens from the CNS, and are able to mount an immune response back into the brain. During neuroinflammatory diseases, the brain is invaded by autoreactive T cells. Based on your knowledge of the CNS lymphatics, which of the following statements could be correct: A. If the brain's lymphatics are an avenue for the T cells into the brain, then removal (or blockage) of the lymphatics should reduce the pathology of these diseases B. Dissection and removal of the lymphatic vessels will have no effect on neuroinflammation because the glymphatic system can compensate C. Removal of the cervical nodes will only affect CNS immune surveillance D. Opening the blood-brain barrier will divert the T cells and prevent their entrance into the brain

A. If the brain's lymphatics are an avenue for the T cells into the brain, then removal (or blockage) of the lymphatics should reduce the pathology of these diseases

What would be an explanation for the choroid plexus' highly vascularized tissue? A. It needs access to the blood to carry out its functions B. It generates more waste than normal epithelium, hence requires more blood flow C. Like the kidneys, it acts as a filter of the brain's blood supply D. Like the liver, it secretes important molecules that need to be disseminated throughout the body.

A. It needs access to the blood to carry out its functions

The CSF flows in what direction? A. Lateral ventricles -> third ventricle -> fourth ventricle -> central canal B. Interventricular foramina -> third ventricle -> fourth ventricle -> cerebral aqueduct C. Lateral ventricles -> interventricular foramina -> cerebral aqueduct -> third ventricle D. Meninges -> fourth ventricle -> cerebral aqueduct -> third venticle

A. Lateral ventricles -> third ventricle -> fourth ventricle -> central canal

Who injected melted wax into a brain to reveal the exact nature of the brain's ventricles? A. Leonardo DaVinci B. Madame Tussauds C. Claudius Galen D. Hippocrates

A. Leonardo DaVinci

There are 3 cellular barriers in the CNS A. The blood-CSF barrier, the meningeal barrier, and the BBB B. The choroid plexus, the dura mater, and the BBB C. The dura mater, the meningeal barrier, the BBB D. The blood-CSF barrier, the choroid plexus, and the arachnoid

A. The blood-CSF barrier, the meningeal barrier, and the BBB

Disorders like Alzheimer's and Parkinson's are thought to be a consequence of the accumulation of misfolded proteins in the brain. Which of the following statements could be correct? A. The glymphatic system is not working correctly, resulting in accumulation of these proteins B. The lymphatic system is not working correctly, resulting in accumulation of these proteins C. The vasculature in the brain is not working correctly, resulting in accumulation of these proteins D. The CSF/ventricular system is not working correctly, resulting in accumulation of these proteins

A. The glymphatic system is not working correctly, resulting in accumulation of these proteins

The glymphatic system was described in 2012, at a time when it was believed the brain had no conventional lymphatic vessels. What is the main difference between the glymphatic system and the recently described CNS lymphatic system? A. The identity of the drainage: one mostly drains into venous blood, the other into lymph nodes (directly or indirectly) B. The identity of the waste materials that move through them C. The structure of each system (i.e. either closed or open-ended circulatory network) D. The function of each system: one degrades the waste the other only filters it

A. The identity of the drainage: one mostly drains into venous blood, the other into lymph nodes (directly or indirectly)

Which of the following are instances that highlight drawbacks of the neuroimmune system? A. The parenchyma of the brain can serve as a safe haven for tumors and encapsulated pathogens B. The CSF-filled spaces do not have access to lymphatics C. The ventricles are surrounded by BBB, preventing easy access of immune cells D. The neuroanatomy of the CNS both prevent foreign particles entry but also CNS-specific antigens from exiting into the peripheral circulation

A. The parenchyma of the brain can serve as a safe haven for tumors and encapsulated pathogens

There are various types of vessels in the brain. Which of the following statements is correct? A. There are intracranial vessels in the surface of the brain involved in removing used blood. B. The microcapillaries of the brain have only one layer of smooth muscle cells surrounding them. C. All of the brain vessels are made up by endothelial cells that resemble more the epithelium than the endothelium of the periphery. D. The brain capillaries are similar to that of other highly perfused organs, like the kidney.

A. There are intracranial vessels in the surface of the brain involved in removing used blood.

During a routine visit to your primary doctor, the physician finds enlarged lymph nodes in your neck. What could be the cause of this enlargement? A. You have an infection and immune cells in the node closest to the infection (neck) are actively dividing and specializing in killing the invader B. You have drank too much water causing the lymph nodes to innundate C. You have a defect in your skin D. The node is actively absorbing nutrients and lipids and have become swollen due to lack of space

A. You have an infection and immune cells in the node closest to the infection (neck) are actively dividing and specializing in killing the invader

The change in membrane potential by a flux of ions results in [blank], which is an electrical impulse that moves down the membrane and into the neighboring cell A. an action potential B. an ionic wave C. synaptic plasticity D. depolarization of the membrane

A. an action potential

What will happen if T cells cross into perivascular spaces and fail to be activated by antigen-presenting cells? A. nothing, they will just scan the area and if nothing is found, head back into the circulation B. Either undergo apoptosis ora are removed via CSF-drainage pathways C. They will immediately cross the glia limitans into the brain D. They will destroy the astrocyte's endfoot, generating a hole in the glia limitans

A. nothing, they will just scan the area and if nothing is found, head back into the circulation

Which of the following is a correct description of the choroid plexus? A. specialized parts of the walls of the ventricles made up by ependymal cells B. Contains a single layer of cylindrical epithelial cells C. Is formed by microvilli that constantly oscillates D. Contains the blood-meningeal barrier

A. specialized parts of the walls of the ventricles made up by ependymal cells

The two main immune cell types in the CNS are perivascular macrophages and microglia cells. They are located, and survey in which areas of the brain? A. the perivascular space and the parenchyma of the brain, respectively B. The meninges and the brain parenchyma and spinal cord, respectively C. The grey matter and the white matter, respectively D. the perivascular spaces and the meninges, respectively

A. the perivascular space and the parenchyma of the brain, respectively

The high degree of folding of the cerebral cortex creates more space for neurons, which is postulated to allow what of the following: A. Move and coordinate all our limbs B. Cognition and reasoning C. To have at least 9 senses D. To multitask (like walk and talk at the same time)

B. Cognition and reasoning

The choroid plexus plays an important role in the brain's immune system because A. Is the primary site for red blood cell entry into the brain B. Is the entryway of immune cells into the perivascular spaces (meninges) C. Is thought to be the source of microglia as they differentiate form ependymal cells D. Controls the entry of foreign substances, including pathogens

B. Is the entryway of immune cells into the perivascular spaces (meninges)

How does a signal flow through the nervous system? A. dendrite -> axon -> soma -> synapse -> dendrite B. Synapse -> dendrite -> soma -> axon -> synapse C. Axon -> soma-> dendrite -> synapse -> axon D. Soma -> axon -> synapse -> axon -> soma

B. Synapse -> dendrite -> soma -> axon -> synapse

What major brain structures are being shown in this picture? A. The 4 cardinal points B. The 4 lobes and the stem C. The 5 hemispheres D. The 4 lobes and the ventricle

B. The 4 lobes and the stem

Which of the following best describe the brain's immune defenses? A. The various cellular barriers and microglia B. The BBB, microglia, and all the perivascular antigen-presenting cells (such as epiplexus cells) C. The meninges, the CSF, and the skull D. The lymphatic and glymphatic system

B. The BBB, microglia, and all the perivascular antigen-presenting cells (such as epiplexus cells)

The importance of T(reg) cells in the brain's immune system is best depicted by which statement? A. They promote infection clearance by expressing highly inflammatory markers that aid on pathogen killing B. They regulate the immune response and coordinate the shift from inflammatory to anti-inflammatory (healing) C. Whenever cytotoxic T cells enter the brain they are turned into T (regs) by the CNS environment, ensuring that there are never inflammatory cells inside the brain D. They can respond to neurotransmitters like serotonin, which allow them to respond and follow brain's signals

B. They regulate the immune response and coordinate the shift from inflammatory to anti-inflammatory (healing)

The term "neurovascular unit" refers to a group of what components? A. basement membrane, pericytes, astrocytes, and neurons B. neurons, astrocytes, pericytes, basal membrane, an endothelial cells C. Basement membrane, pericytes, microglia, neurons, and astrocytes D. Red blood cells, astrocytes, pericytes, basal membrane, and endothelial cells

B. neurons, astrocytes, pericytes, basal membrane, an endothelial cells

Which of the following is NOT a function of the CSF? A. Decreases the effective weight of the brain by ~90% B. Cushions the brain and spinal cord from physical trauma, reducing the impact on the tissue C. Allows blood into the brain parenchyma to ensure good oxygenation D. removes waste products from the CNS

C. Allows blood into the brain parenchyma to ensure good oxygenation

Because of the high metabolic rate of neurons, the brain generates high amounts of wastes. Which of the following is the best description of how the brain removes its waste? A. High expression of transporters specific for waste that pumps them out of the neurons B. Ependymal cells actively absorb the waste products and degrade them C. Bulk flow of CSF and ISF moving through the parenchyma of the brain removes the wastes D. Aquaporin channels of ependymal cells produce a flow of water out of the brain into the ventricles

C. Bulk flow of CSF and ISF moving through the parenchyma of the brain removes the wastes

The brain is involved in processing or directing all of the following except: A. taste, vision, touch, smell, and hearing B. Movement and response to stimuli C. Food degradation and absorption D. Learning, talking, and emotions

C. Food degradation and absorption

Which of the following statements best describes the neurolymphatic system? A. Is a unique blind-ended unidirectional, absorptive and transport system that penetrates deep into the brain tissues B. It consists of a multitude of lymphatic vessels that drain into the cervical lymph nodes and associated lymphatic organs such as the thymus C. It is present throughout the meninges and constantly scans the CSF and ISF for foreign compounds. D. It only scans, and surveys the CSF for foreign particles and does not have access to the parenchyma of the brain, hence this area cannot be monitored

C. It is present throughout the meninges and constantly scans the CSF and ISF for foreign compounds.

A scientist has discovered a drug to treat a specific type of brain infection. The drug is ionized at the pH of human blood, which means that A. It will be actively absorbed by the BBB B. It will passively diffuse through the BBB C. It will not pass through the BBB D. It will pass into the endothelial cells and remain trapped there

C. It will not pass through the BBB

What are the two main ways transport of any substance occurs through the BBB? A. Perivascular and paracellular transport B. Paracellular and transvascular transport C. Paracellular and transcellular transport D. Perivascular and transvascular transport

C. Paracellular and transcellular transport

Which of the following are functions carried out by the BBB? A. regulates the composition of the cerebrospinal fluid B. Controls the passage of bone-marrow stem cells into the brain C. Protects the brain from foreign substances in the blood by restricting their passage D. provides the brain with a source of energy in the form of lipids

C. Protects the brain from foreign substances in the blood by restricting their passage

Which of the following is NOT a function of the glymphatic and lymphatic system? A. The glymphatic pathway is important for the brain-wide delivery of nutrients like glucose. B. Both the CSF and ISF function in clearing extracellular metabolites and waste products from the parenchyma of the brain C. Suppression of the glymphatic and lymphatic systems will result in defects in CSF volume D. Both CSF and ISF are scanned and surveyed by immune cells looking for PAMPs and DAMPs

C. Suppression of the glymphatic and lymphatic systems will result in defects in CSF volume

Evolutionarily speaking, what three parts of the brain can be put in order of appearance during evolution, starting with the ancient part on the left to the newest addition on the right? A. The hindbrain -> midbrain -> the forebrain B. The cortex -> the brain stem -> the cerebellum C. The brain stem -> the cerebellum -> the cerebrum D. The cerebellum -> the cortex -> the spinal cord

C. The brain stem -> the cerebellum -> the cerebrum

Which of the following statements is the most accurate description of neuroglia? A. They are the glue that keeps the nervous system intact B. They are electrically non-excitable cells that support the function of the brain C. They are the homeostasis-maintaining cells of the nervous system D. Is the collective name for all the cell types present in the brain and spinal cord

C. They are the homeostasis-maintaining cells of the nervous system

Because the brain's lymphatics are restricted to its surface, how do they still sample the parenchyma for the presence of antigens? A. Through T cells that constantly go inside and scan the brain parenchyma B. Through microglia, which when activated (by antigens) migrate out of the parenchyma and into the lymphatics C. Through the glymphatic system, which removes waste (and antigens) from the parenchyma into the SAS, where is now available to be sampled by the lymphatics D. Through arteries and veins that run parallel to the lymphatics and interexchange solutes (and antigens)

C. Through the glymphatic system, which removes waste (and antigens) from the parenchyma into the SAS, where is now available to be sampled by the lymphatics

What creates (or maintains) the flow of CSF throughout the CNS? A. extensions like cilia, flagella, and pseudopodia emanating from ependymal cells B. The beating back and forth of microvilli C. The alternating pressure changes on the vasculature caused by the heartbeat. D. A combination of the pressure changes in the vasculature and motile cilia in ependymal cells

D. A combination of the pressure changes in the vasculature and motile cilia in ependymal cells

Which of the following is NOT a function of the lymphatic system? A. support the immune system by providing space for activation of lymphocytes B. Return excess protein and interstitial fluid (ISF) in the tissues back to the blood C. Allows absorption of nutrients passing through your intestines D. Absorb CSF from the dura mater space and drains it into the gut for disposal

D. Absorb CSF from the dura mater space and drains it into the gut for disposal

Hydrocephalus is a neurological disease caused by excessive accumulation of CSF. This can be caused by which of the following? A. A malformation during fetal development B. Injuries to the brain, including physical trauma or tumor growth C. Infections of the brain or spinal cord D. All of the above

D. All of the above

Which of the following observation questioned the "immune privileged" status of the brain? A. The constant presence of lymphocytes (albeit at low levels) in the CSF-filled compartments B. That nonself-tissue transplanted into ventricles is rejected C. That a substantial amount of the CSF drains into cervical lymph nodes D. All the above E. A and B F. A and C

D. All the above

What are the two broad types of receptors in a synapse? A. ionotropic and ionophobic B. metabotropic and ionophobic C. ionophobic and metabotropic D. Ionotropic and metabotropic

D. Ionotropic and metabotropic

Which of the following is NOT a property of the BBB? A. Play an important role in regulating water transport through the astrocytes' end-feet B. Exhibit significantly higher pericyte coverage compared with peripheral vessels C. Is permeable to activated immune cells or recruit naive cells when the endothelial cells are activated D. Is located throughout all the brain vasculature

D. Is located throughout all the brain vasculature

What are the predominant types of cells in the white matter of the brain? A. Endothelial cells and nerve cells' soma and dendrites B. Schwann cells and nerve cells' axons C. Neurons' soma and dendrites and oligodendrocytes D. Oligodendrocytes and neurons' axons

D. Oligodendrocytes and neurons' axons

Which of the following is NOT a feature of ependymal cells? A. Cellular junctions, including tight junctions, adherens junctions, and desmosomes B. Microvilli and cilia C. Close proximity to vasculature D. They form a barrier as impermeable as the BBB

D. They form a barrier as impermeable as the BBB

Which of the following ideas was consistent with the "immune privilege" hypothesis? A. The BBB prevented entry of immune cells into the parenchyma of the brain B. The lack of conventional lymphatic organs in the brain C. The lack of an immune response towards the injection of antigens directly into the ventricles D. All of the above E. A and B F. A and C

E. A and B

Inflammation plays various important roles in an organism. These are A. killing of pathogens B. healing of tissues C. removal of wastes and foreign bodies D. A and B E. A, B, and C

E. A, B, and C

Various features that explain the uniqueness of the neuroimmune system are A. Rigid layers preventing swelling B. Presence of BBB controlling migration of immune cells C. Absence of traditional lymphatics directly innervating the brain parenchyma. D. A and B E. A, B, and C

E. A, B, and C

What are examples of synapses? A. Axon with dendrite B. Axon with spine C. Axon with axon D. a and b E. a, b, c

E. a, b, c

A leaky BBB will cause edema (swelling) in the brain due to the influx of immune cells that can now cross the barrer

Fale, probably water and blood

All of the lymph trunks in the body drain into the one lymph duct, which in turn return lymph to the blood by emptying into the left jugular vein

False, 3/4 into thoracic duct and 1/4 into right lymphatic duct

The glymphatic system is a recently discovered vasculature that utilizes CSF as a waste removal conduit to remove toxins and metabolism by products

False, ??

A defect in the function of the choroid plexus will lead to disease, regardless of the magnitude of the defect as the brain will not be able to compensate

False, brain can compensate by changing amount of arachnoid villus

The components of the lymph are the same regardless of the position in the body of the lymphatics

False, can vary depending on location in body

There are some areas of the brain that lacks any type of barrier, such as the choroid plexus

False, choroid plexus maintains blood-CSF barrier

In any part of the brain you will find three types of cells: neurons, neuroglia, and epithelial cells

False, epithelial cells are only found in the ventricles

One of the main support functions of the lymphatic system is the direct delivery of fats to the brain

False, fats aren't normally delivered to the brain rather glucose

Continuous capillaries are more permeable than capillaries with fenestrations

False, fenestrated capillaries are more permeable

Nerves in your toes are connected to the brain by a long axon going through the spinal cord

False, many smaller nerves synapse in between to connect brain to toes

When a fresh brain is cut open, the area enriched in neuronal cell bodies appear white, hence is called gray matter

False, neuronal cell bodies will appear gray

The 'all or nothing law' of cellular excitation establishes that neurons can regulate the action potentials

False, neurons can't control whether or not they fire

The special neurons of the cerebral cortex can process complex signals because the harbor multiple axons

False, neurons only have one axon

Lymph contains water, proteins, immune cells, and red blood cells

False, no red blood cells

The CNS parenchyma is completely cut-off from the immune system, while the perivascular compartments (including ventricles) have active immune systems

False, not completely cut-off

The glymphatic and lymphatic systems run parallel to each other in the brain (i.e. two flows side by side)

False, not separate system, work in conjunction with each other

The term "glymphatic" refers to the importance of glial cells in the system and the similarities of the liquid conduit with the blood vasculature

False, similar to the lymphatic system not blood

All the capillaries in your body have an associated lymphatic network

False, the microcapillaries in the brain lack lymphatic vessels

Excessive CSF production, owing to overproduction, obstructed flow, or limited resorption of CSF, is beneficial to the brain

False, would lead to pressure buildup at the base of the spine

Unlike the BBB, the vasculature in the choroid plexus contains fenestrated endothelial cells, which would normally limit diapedesis of leukocytes through the barrier

False, would not limit diapedesis

pluripotent cells that give rise to other glia, in particular oligodendrocytes

NG2

Desmosomes

a type of cellular junction that links the cell to the extracellular matrix

A neuroglia with a characteristic star-like morphology

astrocyte

Many nerves come together to form nerve fibers, which also can come together to form thick bundles called nerve tracts. The largest of these is called the [blank], which forms a bridge between the brain's [blank]

corpus callosum, hemispheres

The limbic system is a group of structures that regulates out [blank] (mostly) and includes [blank]

emotions, hypothalamus, thalamus, hippocampus, amygdala

epithelial cells that form the walls of the choroid plexus

ependymal

Antigen presenting cells are constantly cycling between lymph nodes and perivascular spaces via lymphatics

false, lymphatics are unidirectional- cells must travel through blood too

The brain's ventricular and subarachnoid spaces exhibit the same immune privilege as the brain parenchyma

false, ventricular and SAS have active immune systems

The brain is a [blank] ball, with the empty space inside filled with a liquid called [blank]

hollow, cerebrospinal fluid

cells in charge of myelination in CNS, similar to schwann cells in PNs

oligodendrocytes

Intracerebral arteriole

only have 1 layer of smooth muscle but have pericytes and astrocytes

split-brain experiments

related to absence of the corpus callosum

HPA axis

related to limbic system during stressful situations

Frontal lobe

responsible for attention, planning, and decision making

Circle of Willis

the area where several main arteries join and share blood between them

Specialized endothelial cells

the cells lining the vasculature at the blood-brain barrier

The neurovascular unit

the complex structure formed by all the entities associated to the brain's microcapillaries

Meninges

the dura, arachnoid, and pia maters

Part of the PNS

the enteric nervous system

The spinal tap is a procedure possible because the [blank] grows faster than the [blank]

vertebral column, spinal cord