CNSI

Question 1

Direct injection of virulent bacteria into the brain of an animal seldom results in abscess. Which of the following conditions can increase the chances of an abscess occurring?

a. Injecting culture media along with the bacteria
b. Causing necrosis of the tissue at the time bacteria is inoculated
c. Infarction of brain tissue causing a necrotic nidus
d. All of the above

Answer 1

d. All of the above

Adams p697

Question 2

Which of the following sources or causes of a CNS infection usually results with more than one type of bacterial flora being isolated (mixed infections)?

a. Hematogenous infection in the course of bacteremia
b. Septic embolus from infected lungs
c. Infections that follow neurosurgery
d. Insertion of a cranial appliance

Answer 2

b. Septic embolus from infected lungs Adams p697

Question 3

In acute meningeal inflammation, a pure pia-arachnoiditis will present as which of the following?

a. Headache, stiff neck
b. Confusion, stupor, coma
c. Ocular palsies,
d. Focal seizures

Answer 3

a. Headache, stiff neck

Adams p699 Table 32-1

Question 4

Which of the following is the less frequent cause of sporadic bacterial meningitis?

a. H. influenza
b. N. meningitides
c. Staphylococcus aureus
d. S. pneumoniae

Answer 4

d. S. pneumoniae

Adams p700

Question 5

The following criteria are part of the clinical prediction rule developed by Nigrovic, which classifies patients as low risk for bacterial meningitis if they LACK the following criteria, EXCEPT:

a. Positive CSF gram stain
b. CSF absolute neutrophil count of at least 1,000 cells/mL
c. CSF protein of at least 80 mg/dL
d. CSF glucose below 40 mg/dL
e. A history of seizure at or after the time of presentation

Answer 5

d. CSF glucose below 40 mg/dL

Adams p703

Question 6

Which of the following laboratory findings would be least helpful?

a. Blood cultures
b. Cultures of the oropharynx
c. Cultures of the nasopharynx
d. Leukocyte count

Answer 6

b. Cultures of the oropharynx

Adams p703

Question 7

CSF findings of patients with fungal meningitis are similar to patients with tuberculous meningitis. Which of the following is NOT a typical CSF finding for fungal meningitis?

a. Pleocytosis of > 2,000/mm3
b. Low glucose
c. Protein elevated to very high levels
d. CSF pressure is elevated

Answer 7

a. Pleocytosis of > 2,000/mm3

Adams P731

Question 8

Which of the following protozoal diseases has the worst prognosis, resulting in death within a week of onset?

a. Toxoplasmosis
b. Amebic meningoencephalitis
c. Malaria
d. Trypanosomiaiass

Answer 8

b. Amebic meningoencephalitis

Adams P735

Question 9

Which of the following diseases caused by parasites usually present with mild gastroenteritis followed by myositis?

a. Trichinosis
b. Cysticercosis
c. Schistosomiasis
d. Toxoplasmosis

Answer 9

a. Trichinosis

Adams P736

Question 10

Which of the following trematodes causes lesions that tend to localize in the spinal cord causing an acute or subacute myelitis?

a. Schistosoma haematobium
b. Schistosoma japonicum
c. Schistosoma mansoni
d. Paragonimus

Answer 10

c. Schistosoma mansoni

Adams p739

Question 11

The following signs and symptoms are usually present with the clinical syndrome of aseptic meningitis EXCEPT:

a. Acute onset
b. Headache
c. Photophobia
d. Kernig and Brudzinski signs Adams p744

Answer 11

d. Kernig and Brudzinski signs

Adams p744

Question 12

Which of the following viruses is the most common cause of aseptic meningitis?

a. Adenovirus
b. Enterovirus
c. HSV-2
d. HSV-1

Answer 12

b. Enterovirus

Adams p744

Question 13

Among the following viral encephalitides which has the highest mortality and morbidity?

a. Eastern equine encephalitis
b. Herpes simplex encephalitis
c. Western equine encephalitis
d. La Crosse encephalitis

Answer 13

a. Eastern equine encephalitis

Adams p749

Question 14

Which of the following is the most common sporadic cause of encephalitis and has no seasonal or geographic predilection?

a. Eastern equine encephalitis
b. Herpes simplex encephalitis
c. Western equine encephalitis
d. La Crosse encephalitis

Answer 14

b. Herpes simplex encephalitis Adams p749

Question 15

Which of the following encephalitides has characteristic distribution of lesions such that a diagnosis can be made by appearance on imaging studies?

a. Eastern equine encephalitis
b. Herpes simplex encephalitis
c. Western equine encephalitis
d. La Crosse encephalitis

Answer 15

b. Herpes simplex encephalitis

Adams p752

Question 16

Which of the following enteroviruses clinically can cause an illness that resembles poliovirus infections?

a. Coxsackie groups A and B
b. Japanese encephalitis
c. West Nile virus
d. All of the above

Answer 16

d. All of the above

Adams p763

Question 17

Eosinophilic inclusions found in the cytoplasm and nuclei of neurons and glial cells are the pathologic hallmarks of which of the following conditions?

a. Poliomyelitis
b. Subacute Sclerosing Panencephalitis
c. Progressive Multifocal Leukoencephalopathy
d. Encephalitis Lethargica

Answer 17

b. Subacute Sclerosing Panencephalitis

Adams p766

Question 18

Which of the following laboratory examinations is usually normal in patients with subacute spongiform encephalopathy?

a. routine CSF studies
b. EEG
c. MRI
d. Tonsillar staining with antibodies

Answer 18

a. routine CSF studies

Adams p771

Question 19

Which of the following subacute and chronic viral infections is considered treatable in AIDS patient with remission in almost half of cases for a year?

a. Progressive Multifocal Leukoencephalopathy
b. Subacute sclerosing panencephatlis
c. Progressive rubella panencephalitis
d. Encephalitis lethargica

Answer 19

a. Progressive Multifocal Leukoencephalopathy

Adams p767

Question 20

Which of the following organisms causing viral encephalitis is known to cause a delayed extrapyramidal syndrome?

a. Japanese B
b. JC virus
c. HSV
d. Measles

Answer 20

a. Japanese B

Adams 768