Block 13 CNS Infections MCQ's

23 Questions | Total Attempts: 1414

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Block 13 CNS Infections MCQ

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

  • 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

  • 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

  • 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

  • 5. 
    • A. 

      Forest rodents

    • B. 

      Raccoons

    • C. 

      Humans

    • D. 

      Bats

    • E. 

      Wild birds

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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