Block 13 CNS Infections MCQ's
Questions and Answers
- 1.
Spinal tap is contraindicated in patients with
- A.
Acute purulent meningitis
- B.
Acute viral meningitis
- C.
Encephalitis
- D.
Intracranial or spinal mass lesion
Correct Answer
D. Intracranial or spinal mass lesionExplanation
Spinal tap, also known as a lumbar puncture, is a procedure in which a needle is inserted into the spinal canal to collect cerebrospinal fluid for diagnostic purposes. However, it is contraindicated in patients with intracranial or spinal mass lesions. This is because performing a spinal tap in these patients may cause increased pressure within the spinal canal, leading to potential complications such as herniation of the brain or spinal cord. Therefore, it is important to avoid performing a spinal tap in patients with known or suspected mass lesions in order to prevent further harm.Rate this question:
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- 2.
A 54-year-old white male who emigrated from UK to Virginia 5 years ago developed symptoms of mental confusion and unsteady gait. During a progressive illness lasting 4 months he became disabled, bed-ridden, and died. His brain at autopsy showed spongiform encephalopathy. What characterizes this pathogen?
- A.
A spirochete that is latent for years and causes gummatous inflammation
- B.
A virus carried by bats and raccoons that has negative-sense RNA
- C.
A protein that is transmissible by eating beef and is sensitive to proteases
- D.
A protein that is carried by animals and has an incubation period of 7 years or longer
Correct Answer
D. A protein that is carried by animals and has an incubation period of 7 years or longerExplanation
The correct answer is "A protein that is carried by animals and has an incubation period of 7 years or longer". This answer is supported by the information given in the question, which states that the patient developed symptoms after 5 years of emigrating from the UK. Additionally, the presence of spongiform encephalopathy in the brain at autopsy suggests a prion disease, which is caused by abnormal proteins that can be transmitted through consumption of contaminated animal products. The long incubation period is also characteristic of prion diseases.Rate this question:
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- 3.
A 44-year-old African-American homeless male alcoholic in Miami is brought to the ER by a friend because he was not eating much for a month and was “acting strange.” He was febrile, emaciated, lethargic, and disoriented. The cerebrospinal fluid fluid showed 620 white blood cells per mm3, which were all mononuclears, and a low glucose of 24 mg/dL. The Gram stain and fluorochrome stains revealed no organisms. What is a likely diagnosis?
- A.
Coccidioidomycosis
- B.
Cryptococcosis
- C.
Lyme disease
- D.
Tuberculosis
Correct Answer
D. TuberculosisExplanation
The likely diagnosis in this case is tuberculosis. The patient's symptoms of febrile, emaciated, lethargic, and disoriented, along with the findings of high white blood cell count in the cerebrospinal fluid and low glucose levels, are consistent with central nervous system tuberculosis. The absence of organisms on Gram stain and fluorochrome stains does not rule out tuberculosis, as the bacteria may be difficult to visualize. Additionally, the patient's risk factors of being homeless, alcoholic, and African-American also increase the likelihood of tuberculosis.Rate this question:
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- 4.
A 57-year-old Caucasian insurance salesman from Pennsylvania comes to the ER with a 2-day history of fever, headache, and mental confusion. He has nuchal rigidity and is stuporous. Cerebrospinal fluid shows 450 leukocytes per mm3 with 96% polymorphonuclears. The glucose in the cerebrospinal fluid is low at 32 mg/dL. The internal medicine resident suspects the patient has one of two common pathogens with these features:
- A.
Bacteria that are Gram-positive bacilli or cocci
- B.
Bacteria that are Gram-negative bacilli or cocci
- C.
A virus carried by mosquitoes or a spirochete carried by ticks
- D.
Bacteria that will grow best on chocolate agar
Correct Answer
A. Bacteria that are Gram-positive bacilli or cocciExplanation
Based on the given information, the patient presents with symptoms of fever, headache, mental confusion, nuchal rigidity, and low glucose levels in the cerebrospinal fluid. These findings are indicative of bacterial meningitis. The presence of 450 leukocytes per mm3 with 96% polymorphonuclears further supports a bacterial infection. Gram-positive bacteria are commonly associated with meningitis, specifically bacilli or cocci. Therefore, the patient is likely to have an infection caused by Gram-positive bacteria.Rate this question:
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- 5.
A 68-year-old gardener presents to the emergency department with a 3-day history of fever, headache, myalgias, and weakness. He is awake but is confused and oriented only to person. Muscle strength is markedly diminished in the lower extremities and somewhat reduced in the upper extremities. Deep tendon reflexes are absent throughout. Acute serum and CSF samples revealed elevated levels of IgM antibodies to West Nile virus. What is the most common reservoir of the causative agent?
- A.
Forest rodents
- B.
Raccoons
- C.
Humans
- D.
Bats
- E.
Wild birds
Correct Answer
E. Wild birdsExplanation
The main mode of WNV transmission is via various species of mosquitoes which are the prime vector, with **** birds ***** being the most commonly infected animal and serving as the prime reservoir host - especially passerines which are of the largest order (Passeriformes) of birds. WNV has been found in various species of ticks, but current research suggests they are not important vectors of the virus. WNV also infects various mammal species including humans and has been identified in reptilian species, including alligators and crocodiles, and also in amphibians. Not all animal species which are susceptible to WNV infection – humans included, and not all bird species develop sufficient viral levels to transmit the disease to noninfected mosquitoes, and are thus not considered major factors in WNV transmission.[Rate this question:
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- 6.
A 68-year-old gardener presents to the emergency department with a 3-day history of fever, headache, myalgias, and weakness. He is awake but is confused and oriented only to person. Muscle strength is markedly diminished in the lower extremities and somewhat reduced in the upper extremities. Deep tendon reflexes are absent throughout. Acute serum and CSF samples revealed elevated levels of IgM antibodies to West Nile virus. Which of the following best describes the characteristics of the causative agent?
- A.
Enveloped, single-stranded, positive-sense RNA virus
- B.
Naked, single-stranded, positive-sense, RNA virus
- C.
Enveloped, single-stranded, negative-sense RNA virus
- D.
Naked, single-stranded, negative-sense RNA virus
- E.
Enveloped, double-stranded DNA virus
Correct Answer
A. Enveloped, single-stranded, positive-sense RNA virusExplanation
The correct answer is "Enveloped, single-stranded, positive-sense RNA virus". This is because West Nile virus is a member of the Flaviviridae family, which are enveloped, single-stranded, positive-sense RNA viruses. The presence of IgM antibodies to West Nile virus in the serum and CSF samples confirms the infection with this specific virus.Rate this question:
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- 7.
A 49-year-old female physician has a 2-month history of increasing forgetfulness, difficulty reading, loss of interest in her appearance, and walking with a jerky, wide-based gait. She has been unable to work for several weeks. Her past medical history is unremarkable, and she takes no medications. Family medical history is noncontributory. On physical examination, the patient is alert but is uncommunicative and uncooperative. There is bilateral horizontal nystagmus and decreased visual acuity. The gait is wide-based and ataxic. A prominent resting tremor of the hands is noted. Motor strength is good throughout, but several myoclonic jerks of the upper and lower extremities are noted. A lumbar puncture is performed. The only abnormal CSF finding is a protein of 98 mg/dL. Which of the following CSF studies would be most helpful in supporting the probable diagnosis?
- A.
VDRL test for syphilis
- B.
Measurement of amyloid-β
- C.
Measurement of 14-3-3 protein
- D.
Measurement of microtubule-associated protein tau
- E.
Histologic examination for Negri bodies
Correct Answer
C. Measurement of 14-3-3 proteinExplanation
Elevated amounts of 14-3-3 proteins are found in the cerebrospinal fluid of patients with Creutzfeldt-Jakob disease.
14-3-3 proteins are a family of conserved regulatory molecules expressed in all eukaryotic cells.
14-3-3 proteins have the ability to bind a multitude of functionally diverse signaling proteins, including kinases, phosphatases, and transmembrane receptors. More than 100 signaling proteins have been reported as 14-3-3 ligands.
The name 14-3-3 refers to the particular elution and migration pattern of these proteins on DEAE-cellulose chromatography and starch-gel electrophoresis. The 14-3-3 proteins eluted in the 14th fraction of bovine brain homogenate and were found on positions 3.3 of subsequent electrophoresis by Moore and Perez (1967).
The first symptom of CJD is rapidly progressive dementia, leading to memory loss, personality changes and hallucinations. This is accompanied by physical problems such as speech impairment, jerky movements (myoclonus), balance and coordination dysfunction (ataxia), changes in gait, rigid posture, and seizures. The duration of the disease varies greatly, but sporadic (non-inherited) CJD can be fatal within months or even weeks (Johnson, 1998). In some people, the symptoms can continue for years. In most patients, these symptoms are followed by involuntary movements and the appearance of an atypical diagnostic electroencephalogram tracing. Most victims die six months after initial symptoms appear, often of pneumonia due to impaired coughing reflexes. About 15% of patients survive two or more years.
The symptoms of CJD are caused by the progressive death of the brain's nerve cells, which is associated with the build-up of abnormal prion proteins forming amyloids. When brain tissue from a CJD patient is examined under a microscope, many tiny holes can be seen where whole areas of nerve cells have died. The word "spongiform" in "transmissible spongiform encephalopathies" refers to the sponge-like appearance of the brain tissue.Rate this question:
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- 8.
A 35-year-old woman is hospitalized because of fever, headache, and confusion of 24 hours’ duration. Her past medical history is significant for a cadaveric renal transplantation 10 months ago. Current medications include prednisone and azathioprine. Three weeks ago she attended a party, where she ate processed meats and a variety of cheeses. One day later she developed loose stools and a low-grade fever that lasted 24 hours. The day prior to hospital admission, the fever returned and she developed a headache. The total WBC count is 18,500/mm3. A lumbar puncture is performed. CSF leukocyte count is 1,500/mm3 with a predominance of PMNs, glucose is decreased, and protein is increased. A diphtheroid-like organism is seen on Gram stain of the CSF. The isolate grew best at 4 degrees C. What is the most likely causative agent?
- A.
Streptococcus pneumonia
- B.
Corynebacterium jekium
- C.
Bacillus cereus
- D.
Listeria monocytogenes
- E.
Campylobacter jejuni
Correct Answer
D. Listeria monocytogenesExplanation
The patient's symptoms, including fever, headache, confusion, and gastrointestinal symptoms, along with the CSF findings of increased leukocyte count with PMN predominance, decreased glucose, and increased protein, are consistent with meningitis. The presence of a diphtheroid-like organism on Gram stain of the CSF suggests Listeria monocytogenes as the most likely causative agent. Listeria monocytogenes is a gram-positive bacterium that can cause meningitis, especially in immunocompromised individuals. The fact that the isolate grew best at 4 degrees C is also characteristic of Listeria monocytogenes, which can grow at refrigeration temperatures.Rate this question:
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- 9.
A 27-year-old man was brought to the emergency department with a 1-month history of headache, fever, and altered mental status. He works as a truck driver in Arizona. A lumbar puncture and CSF analysis showed an increased opening pressure, increased WBC count with a predominance of lymphocytes, increased protein, and decreased glucose. No organisms were observed on Gram stain of the CSF. Culture of the CSF grew the organism seen below: What is the most likely disease consistent with this finding?
- A.
Cryptococcosis
- B.
Coccidioidomycosis
- C.
Histoplasmosis
- D.
Paracoccidioidomycosis
- E.
Blastomycosis
Correct Answer
B. CoccidioidomycosisExplanation
The most likely disease consistent with the finding of increased opening pressure, increased WBC count with a predominance of lymphocytes, increased protein, and decreased glucose in the CSF, along with the growth of the organism seen below, is Coccidioidomycosis. This is because Coccidioidomycosis is a fungal infection caused by the organism Coccidioides, which is commonly found in the southwestern United States, including Arizona. This infection can lead to symptoms such as headache, fever, and altered mental status, which are consistent with the patient's presentation.Rate this question:
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- 10.
A 12-year-old boy is admitted with high grade fever, projectile vomiting and neck stiffness and rigidity. After examining the patient and looking at the laboratory reports, the physician explained to the parents that their son was suffering from acute bacterial meningitis. What was the most likely finding on the patient’s CSF report?
- A.
Increased lymphocytes
- B.
Increased glucose
- C.
Increased neutrophils
- D.
Decreased proteins
- E.
Decreased leukocytes
Correct Answer
C. Increased neutrophilsExplanation
In acute bacterial meningitis, the most likely finding on the patient's CSF report would be increased neutrophils. Neutrophils are a type of white blood cell that are typically elevated in response to bacterial infections. The presence of high-grade fever, projectile vomiting, neck stiffness, and rigidity are also consistent with acute bacterial meningitis, further supporting this finding. Increased lymphocytes, glucose, and leukocytes are more commonly associated with viral meningitis, while decreased proteins are not characteristic of meningitis.Rate this question:
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- 11.
An 8-year old child is brought to the clinic because of fever, photophobia, stiff neck, and headache; P.E: shows + Kernig and Brudzinski signs; lumbar puncture shows normal glucose, moderate pleocytosis and low WBC count. PCR was ordered as part of the CSF study. patient died few hours after admission to the hospital. The most likely micoscopic features in the brain of this patient are:
- A.
Cowdry type inclusion bodies in neurons
- B.
Glial cells display cytoplasmic and nuclear inclusions
- C.
Reactive gliosis + giant astrocytes
- D.
Mononuclear cells and activated glia invade the neurons
- E.
Diffuse necrosis, neurofibrillary degeneration
Correct Answer
D. Mononuclear cells and activated glia invade the neuronsExplanation
The presence of mononuclear cells and activated glia invading the neurons suggests an infectious process in the brain. This is consistent with the symptoms of fever, photophobia, stiff neck, and headache, as well as the positive Kernig and Brudzinski signs. The normal glucose, moderate pleocytosis, and low white blood cell count in the cerebrospinal fluid (CSF) also indicate an inflammatory response. These findings are commonly seen in viral meningitis, where immune cells invade the brain tissue in response to the viral infection. The patient's death shortly after admission may be attributed to the severity of the infection and its effects on the central nervous system.Rate this question:
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- 12.
You examine a 15-month-old boy with fever, crying, and vomiting. Because he exhibits nuchal rigidity, you perform a lumbar puncture. CSF analysis shows 250 white blood cells/mm3 (predominantly PMNs), elevated protein, and decreased glucose. You learn that in your Texas border town many immigrants and their children have not been immunized. What measures would you publicize among your patients to prevent the childhood illnesses that could result in meningitis?
- A.
Immunization of infants with Haemophilus influenzae type b vaccine and with Streptococcus pneumoniae protein conjugate vaccine
- B.
Prophylactic antibiotics for family members and day care contacts of any future cases of bacterial meningitis
- C.
Immunization of infants with Haemophilus influenzae type b vaccine and with Streptococcus pneumoniae capsular polysaccharide vaccine
- D.
Immunization of infants with Haemophilus influenzae type b vaccine and with Neisseria meningitidis capsular polysaccharide vaccine
- E.
Immunization of parents of young children with Streptococcus pneumoniae capsular polysaccharide vaccine and with Neisseria meningitidis capsular polysaccharide vaccine
Correct Answer
A. Immunization of infants with Haemophilus influenzae type b vaccine and with Streptococcus pneumoniae protein conjugate vaccineExplanation
The correct answer is to immunize infants with Haemophilus influenzae type b vaccine and Streptococcus pneumoniae protein conjugate vaccine. This is the most effective measure to prevent childhood illnesses that could result in meningitis. Haemophilus influenzae type b and Streptococcus pneumoniae are common pathogens that can cause bacterial meningitis. Immunizing infants with these vaccines helps to protect them from these bacteria and reduces the risk of developing meningitis.Rate this question:
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- 13.
Nancy is a 34-year-old volunteer worker who recently returned to her hometown of Akron, Ohio after a six-week stay in San Salvador working to set up traditional birth clinics for local women as part of a USAID program aimed at reducing maternal deaths during child bearing. While at San Salvador, Nancy was sexually active with her boy friend of several years. After a few days at home, Nancy reported to her doctor with complaints of fever, headache, neck pains, tiredness, muscle ache, confusion, and fine macular rash over her face, neck, trunk and arms. Examination showed she had a temperature of 99.80C. She had moderate neck stiffness and sub-cutaneous petechial hemorrhages over her arms and face as well as the maculo-papular rash. Her muscles were very tender to touch generally and her mini mental state score was 24 (moderately poor). Lumbar puncture was performed and it showed an opening pressure >20 mm of water. Color, clear; protein mildly elevated; sugar, normal; and WBC count 500 (95% lymphocytes). Which of the following problems does Nancy most likely have?
- A.
Acute bacterial meningitis
- B.
Chronic bacterial meningitis
- C.
Acute viral meningitis
- D.
Chronic parasitic meningitis
- E.
Acute fungal meningitis
- F.
Chronic syphilitic encephailitis
- G.
Prion disease
Correct Answer
C. Acute viral meningitisExplanation
Nancy most likely has acute viral meningitis because she is presenting with symptoms such as fever, headache, neck pains, tiredness, muscle ache, confusion, and a macular rash. Additionally, her lumbar puncture results show an opening pressure >20 mm of water, which is consistent with viral meningitis. The presence of lymphocytes in her cerebrospinal fluid also supports this diagnosis. Acute bacterial meningitis would typically present with more severe symptoms and a higher white blood cell count. Chronic bacterial meningitis, chronic parasitic meningitis, acute fungal meningitis, chronic syphilitic encephalitis, and prion disease are less likely given the acute onset of Nancy's symptoms.Rate this question:
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- 14.
The patient is a 56 year old male who had a sexually transmitted disease 20 years ago after an unprotected sexual encounter. He now presents with neurological problems including cognitive and visual problems. On physical examination you would expect his pupils to:
- A.
React to light and accommodate
- B.
Not accommodate
- C.
Not react to light and not accommodate
- D.
Not react to light and accommodate
- E.
React to light
Correct Answer
D. Not react to light and accommodateExplanation
The patient's history of a sexually transmitted disease 20 years ago suggests the possibility of neurosyphilis, which is a late-stage complication of syphilis that can affect the nervous system. Neurosyphilis can cause various neurological problems, including cognitive and visual problems. In neurosyphilis, the pupils may not react to light due to damage to the pupillary reflex pathway in the brain, but they may still be able to accommodate, which means they can adjust their size in response to near vision. Therefore, in this case, you would expect the patient's pupils to not react to light but still accommodate.Rate this question:
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- 15.
Coming home from summer camp a young boy presents with fever, a slight headache and a stiff neck. A spinal tap reveals high protein and low sugar in the CSF. This constellation of symptoms suggests?
- A.
Epidural abscess
- B.
Viral meningitis
- C.
Epidural hematoma
- D.
Acute bacterial meningitis
- E.
Spongiform encephalopathy
Correct Answer
D. Acute bacterial meningitisExplanation
The given symptoms of fever, headache, and stiff neck, along with the findings of high protein and low sugar in the CSF, are indicative of acute bacterial meningitis. This condition is characterized by inflammation of the meninges, the membranes surrounding the brain and spinal cord, and is commonly caused by bacterial infections. The symptoms and CSF findings align with the diagnosis of acute bacterial meningitis.Rate this question:
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- 16.
A 3 month old child was treated for an ear infection, however her mother has noted that the child is irritable and prefers dim light. She brings her back to the hospital where she was admitted following physical examination. A lumbar puncture is done which revealed increased proteins, decreased glucose levels, increased WBCs with increased polymorphs. Based on the findings in this patient, she most likely has
- A.
Viral meningitis
- B.
Bacterial meningitis
- C.
Subarachnoid hemorrhage
- D.
Intracerebral hemorrhage
- E.
No infection
Correct Answer
B. Bacterial meningitisExplanation
Based on the physical examination findings of increased proteins, decreased glucose levels, increased WBCs with increased polymorphs, along with the symptoms of irritability and preference for dim light, the most likely diagnosis is bacterial meningitis. These findings are consistent with the characteristic inflammatory response seen in bacterial meningitis, which includes an increase in white blood cells and proteins in the cerebrospinal fluid, as well as a decrease in glucose levels. Viral meningitis may also present with similar symptoms, but typically has a milder course and less severe laboratory findings. Subarachnoid hemorrhage and intracerebral hemorrhage would present with different symptoms and would not explain the specific findings in this patient.Rate this question:
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- 17.
A 46-year-old male presents with a recurrent headache, low-grade fever, fatigue, and malaise for over a month. He had tolerated the headache by self-medicating with analgesics which afforded temporary pain relief. His wife reports that in the past few days he has become more irritable and intermittently confused. Past medical history revealed the patient had been diagnosed with pulmonary tuberculosis but had been poorly compliant with his anti-tuberculosis medications. On physical examination, a positive Kernig’s sign and a left cranial nerve VI palsy are noted. CT scan of the brain was unremarkable. A chest x-ray is negative except for an old Ghon complex. A lumbar puncture was performed. No organisms were observed on Gram stain of the CSF. What would analysis of the CSF show?
- A.
Neutrophilic pleocytosis, normal protein, decreased glucose
- B.
Lymphocytic pleocytosis, increased protein, normal glucose
- C.
Lymphocytic pleocytosis, increased protein, decreased glucose
- D.
Neutrophilic pleocytosis, increased protein, decreased glucose
- E.
Neutrophilic pleocytosis, decreased protein, increased glucose
Correct Answer
C. Lymphocytic pleocytosis, increased protein, decreased glucoseExplanation
The patient's symptoms, including headache, low-grade fever, fatigue, and malaise, along with the positive Kernig's sign and cranial nerve VI palsy, suggest an inflammatory process in the central nervous system. The negative CT scan and the absence of organisms on Gram stain of the CSF make an infectious cause less likely. Instead, the findings are consistent with meningitis. In meningitis, the CSF analysis typically shows lymphocytic pleocytosis, indicating an increased number of lymphocytes in the CSF. Additionally, there is an increase in protein levels due to inflammation and a decrease in glucose levels due to increased consumption by the inflammatory cells. Therefore, the CSF analysis in this case would show lymphocytic pleocytosis, increased protein, and decreased glucose.Rate this question:
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- 18.
A 44-year-old male suffering from AIDS dies after an attack of meningo-encephalitis. An autopsy shows soap-bubble lesions that are visible with India-ink preparation. Which of the following is the most likely organism responsible for the patient’s condition?
- A.
Mycobacterium tuberculosis
- B.
Cryptococcus
- C.
Creutzfeldt-Jacob disease
- D.
Streptococcus pneumonia
- E.
Neisseria meningitides
Correct Answer
B. CryptococcusExplanation
The correct answer is Cryptococcus. In patients with AIDS, Cryptococcus is a common cause of meningo-encephalitis. The soap-bubble lesions seen on autopsy are characteristic of Cryptococcus infection. India-ink preparation is used to visualize the encapsulated yeast cells of Cryptococcus, which appear as clear halos against a black background. Mycobacterium tuberculosis can cause meningitis in patients with AIDS, but it does not typically present with soap-bubble lesions. Creutzfeldt-Jacob disease is a prion disease that does not cause visible lesions. Streptococcus pneumonia and Neisseria meningitidis are bacterial pathogens that can cause meningitis, but they do not typically present with soap-bubble lesions.Rate this question:
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- 19.
Which preventive strategy will have the greatest impact on central nervous system infections in USA?
- A.
Vaccination of college students and military personnel with meningococcal vaccine
- B.
Vaccination of infants with Haemophilus influenzae Type b vaccine and pneumococcal conjugate vaccine
- C.
Vaccination of infants with Haemophilus influenzae Type b vaccine and live attenuated oral polio vaccine
- D.
Caesarean section delivery of babies when mothers have lesions of genital herpes
Correct Answer
B. Vaccination of infants with Haemophilus influenzae Type b vaccine and pneumococcal conjugate vaccineExplanation
Vaccination of infants with Haemophilus influenzae Type b vaccine and pneumococcal conjugate vaccine would have the greatest impact on central nervous system infections in the USA. Haemophilus influenzae Type b and pneumococcal infections are two major causes of central nervous system infections, such as meningitis, in infants. By vaccinating infants against these two pathogens, the risk of developing central nervous system infections can be significantly reduced. This preventive strategy targets the most vulnerable population and addresses the primary pathogens responsible for these infections.Rate this question:
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- 20.
As an intern you perform a lumbar puncture on a 22 year old male who presents with a headache. Results of the lumbar puncture show increased RBC’s, increased WBC’s (mostly PMN’s), increased protein and decreased glucose. These findings are indicative of:
- A.
Viral meningitis
- B.
Normal findings
- C.
Bacterial meningitis
- D.
Subarachnoid bleed
Correct Answer
C. Bacterial meningitisExplanation
The results of the lumbar puncture, including increased RBCs, increased WBCs (mostly PMNs), increased protein, and decreased glucose, are consistent with bacterial meningitis. This is because bacterial meningitis often causes an inflammatory response in the meninges, leading to an increase in white blood cells (specifically neutrophils), red blood cells may be present due to inflammation and vascular damage, protein levels are elevated due to increased permeability of the blood-brain barrier, and glucose levels are decreased because the bacteria consume glucose. These findings are not consistent with viral meningitis, normal findings, or a subarachnoid bleed.Rate this question:
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- 21.
In patients with acute meningitis, which diagnostic test result is most useful to differentiate bacterial from viral etiology?
- A.
Cerebrospinal fluid glucose concentration and cerebrospinal fluid predominance of lymphocytes or polymorphonuclear leukocytes
- B.
Cerebrospinal fluid protein concentration and cerebrospinal fluid opening pressure
- C.
Results of cerebrospinal fluid culture for bacteria and viruses
- D.
CT scan of brain showing effects of high intracranial pressure
Correct Answer
A. Cerebrospinal fluid glucose concentration and cerebrospinal fluid predominance of lymphocytes or polymorphonuclear leukocytesExplanation
The most useful diagnostic test result to differentiate bacterial from viral etiology in patients with acute meningitis is the cerebrospinal fluid glucose concentration and cerebrospinal fluid predominance of lymphocytes or polymorphonuclear leukocytes. Bacterial meningitis typically causes a decrease in cerebrospinal fluid glucose concentration and an increase in the number of polymorphonuclear leukocytes, while viral meningitis usually results in a normal or slightly decreased glucose concentration and a predominance of lymphocytes. This information can help determine the appropriate treatment and management for the patient.Rate this question:
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- 22.
What is the likely cause of meningitis in a 30-year-old man in upper state New York with fever, facial nerve palsy, and spinal fluid with elevated lymphocytes, elevated protein, and normal glucose?
- A.
Borrelia burgdorferi
- B.
Treponema pallidum
- C.
West Nile virus
- D.
Coxsackievirus
Correct Answer
A. Borrelia burgdorferiExplanation
The likely cause of meningitis in a 30-year-old man in upper state New York with fever, facial nerve palsy, and spinal fluid with elevated lymphocytes, elevated protein, and normal glucose is Borrelia burgdorferi. This is because these symptoms are consistent with Lyme disease, which is caused by Borrelia burgdorferi and is commonly found in upper state New York. Lyme disease can cause meningitis and facial nerve palsy, and the elevated lymphocytes, elevated protein, and normal glucose in the spinal fluid are consistent with the inflammatory response seen in Lyme meningitis.Rate this question:
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- 23.
A 45 year-old female is brought to the emergency room by her husband with the complaint of generalized severe headache which is associated with vomiting. She is flushed and disorientated. She has a temperature of 102.4F a blood pressure of 90/60 and a heart rate of 110 beats/min. On lumbar puncture, one would expect to find
- A.
Increased glucose
- B.
Increased RBC’s and frank blood
- C.
Decreased protein
- D.
Increased protein
Correct Answer
D. Increased proteinExplanation
In a patient with a severe headache, vomiting, flushed appearance, disorientation, and vital signs indicating a possible infection (elevated temperature, low blood pressure, increased heart rate), the most likely diagnosis is meningitis. Meningitis is an inflammation of the meninges, the membranes that surround the brain and spinal cord. In bacterial meningitis, the inflammatory response causes an increase in protein in the cerebrospinal fluid (CSF) obtained through lumbar puncture. This is because the blood-brain barrier becomes more permeable, allowing proteins to leak into the CSF. Therefore, in this case, one would expect to find increased protein on lumbar puncture.Rate this question:
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.JPG "A 27-year-old man was brought to the emergency department with a 1-month history of headache, fever, and altered mental status. He works as a truck driver in Arizona. A lumbar puncture and CSF analysis showed an increased opening pressure, increased WBC count with a predominance of lymphocytes, increased protein, and decreased glucose. No organisms were observed on Gram stain of the CSF. Culture of the CSF grew the organism seen below:
What is the most likely disease consistent with this finding?")
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