Infection - Infection in the CNS

Question 1

infection/ inflammation of the meninges

a.meningitis
b.encephalitis
c.meningoencephalitis
d.prion disease

Answer 1

meningitis

Question 2

which of these meningitis infections is more common and self limiting

a.bacterial
b.viral

Answer 2

b.viral

Question 3

most organisms causing meningitis invade the meninges across which barrier

a.blood brain
b.csf

Answer 3

b.csf

somewhat porous as endothelium of vessels is porous

Question 4

inflammation of the white matter of the brain

a. meningitis
b.encephalitis
c.meningoencephalitis

Answer 4

b.encephalitis

Question 5

most organisms causing encephalitis invade the brain across which barrier

a.blood brain
b.csf

Answer 5

a.blood brain

not fenestrated so harder to penetrate

viruses with tropism for nervous tissue

infection of peripheral nervous system ascends to CNS

eg herpes simplex, varicella zoster and rabies

Question 6

which of these pathogens does NOT invade the peripheral nerves

a.rabies
b.varicella zoster
c.herpes simplex
d.e coli

Answer 6

d.e coli

Question 7

a combination of meningeal and white matter inflammation/ infection

a. meningitis
b.encephalitis
c.meningoencephalitis

Answer 7

c.meningoencephalitis

Question 8

in which of these conditions does the presence of a specific protein alter the configuration of proteins to cause white matter loss

a. meningitis
b.encephalitis
c.meningoencephalitis
d.prion disease

Answer 8

d.prion disease

Question 9

what are the 3 main bacteria that case CNS infections

(NHS)

Answer 9

neisseria meningitis
haemophilus influenza
streptococcus pneumonae

Question 10

what type of bacteria is neisseria meningitis

a.gram positive rod
b.gram positive coccus
c. gram negative rod
d, gram negative coccus

Answer 10

d, gram negative coccus

in pairs so diplococcus

Question 11

what gram stain is haemophilus influenzae type B

a.a.gram positive rod
b.gram positive coccus
c. gram negative rod
d, gram negative coccus
e.gram negative cocco bacillus

Answer 11

e.gram negative cocco bacillus

Question 12

which of these is a gram negative coccus

a.neisseria meningits
b.haemophilus influenzae
c. strep pneumonae

Answer 12

a.neisseria meningits

Question 13

which of these is a gram negative cocco- bacillus

a.neisseria meningits
b.haemophilus influenzae
c. strep pneumonae

Answer 13

b.haemophilus influenzae

Question 14

which of these is a gram positive coccus

a. neiseeria meningitis
b.haemophilus influenzae
c. strep pneumonia

Answer 14

c. strep pneumonia

occurs in pairs so diplococcus

Question 15

what gram stain is strep pneumonae

a.a.gram positive rod
b.gram positive coccus
c. gram negative rod
d, gram negative coccus
e.gram negative cocco bacillus

Answer 15

b.gram positive coccus

in pairs so diplococcus

Question 16

where can all of the 3 main CNS infection bacteria commence ?

a.GI tract
b.GU tract
c.upper respiratory tract
d.lower respiratory tract

Answer 16

c.upper respiratory tract

Question 17

what does meningitis usually occur from

a.direct infection of brain
b.blood stream spread from upper Respiratory tract infection

Answer 17

b.blood stream spread from upper Respiratory tract infection

Question 18

when are the 3 NHS meningitis organisms vaccinated against

a.primary school
b.secondary school
c.adulthood
d.as a baby

Answer 18

a.primary school

Question 19

which organism is a gram positive rod

a.neisseria menigitis
b.haemophilus influenzae
c. strep pneumonae
d.listeria monocytogenes

Answer 19

d.listeria monocytogenes

Question 20

what type of organism is listeria monocytogenes

a.a.gram positive rod
b.gram positive coccus
c. gram negative rod
d, gram negative coccus
e.gram negative cocco bacillus

Answer 20

a.a.gram positive rod

Question 21

which organism is not a common cause of meningitis but is seen in the elderly, neonates and immunocompromised patients

a.neisseria menigitis
b.haemophilus influenzae
c. strep pneumonae
d.listeria monocytogenes

Answer 21

d.listeria monocytogenes

NHS organisms common

Question 22

how is listeria monocytogenes spread

a. droplets
b.food borne
c.close communities
d.dirty water

Answer 22

b.food borne

Question 23

who is commonly effected by TB meningitis

a.elderly
b.neonates
c.teenagers
d.young children

Answer 23

d.young children

Question 24

which type of meningitis occurs shows as a military appearance on chest x ray

a.Nesseria menigitis
b.haemophilus influenzae
c.strep pneunoneae
d.TB

Answer 24

d.TB

disseminated TB

Question 25

pregnant women are advised to avoid food borne sources eg unpasteurised soft cheeses of which pathogen a.Nesseria menigitis b.haemophilus influenzae c.strep pneunoneae d.TB e.listeria monocytogenes

Answer 25

e.listeria monocytogenes vaginal colonisation

Question 26

other than the core list NHS of bacteria causing meningitis in neonates which bacteria should be considered.

Answer 26

GBS - group B strep E coli listeria monocytogenes GEL

Question 27

in early infection (within 7 days) of a neonate with GBS how is the infection acquired a.during birth from mother b.other children c.hospital

Answer 27

a.during birth from mother

Question 28

late infection of a baby with GBS is most likely from what a.mother during birth b. hospital acquired c.other children at nursery

Answer 28

c.other children at nursery

Question 29

a pregnant women is given prophylaxis at the time of delivery for which organism if it is found in the vagina/urine during pregnancy a.GBS b.e coli c. Listeria monocytogenes d.TB

Answer 29

a.GBS type B strep

Question 30

which organism is specifically associated with HIV/AIDS patients and patients recieveing chemotherapy a.GBS b.e coli c. Listeria monocytogenes d.TB e.cryptococcus neoformans

Answer 30

e.cryptococcus neoformans yeast like fungi immunocompromised pre disposed for fungal infections

Question 31

how is CNS infection with cyptococcus neoformans ( HIV/AIDS patients/ chemotherapy) diagnosed a.gram stain b.indian ink stain of blood c.indian ink stain csf

Answer 31

c.indian ink stain csf shows capsule and antigen detection tests

Question 32

what is a significant cause of CNS infection in those with impaired T cell immunity that is associated with cats and a mild fever with swollen lymph nodes a.GBS b.e coli c. Listeria monocytogenes d.toxoplasma gondii e.cryptococcus neoformans

Answer 32

d.toxoplasma gondii

Question 33

which of these is a protozoa a.GBS b.e coli c. Listeria monocytogenes d.toxoplasma gondii e.cryptococcus neoformans

Answer 33

d.toxoplasma gondii

Question 34

other than NHS what organisms are important to consider for CNS infection in immunocompromised patients TLC

Answer 34

Toxoplasma gondii - protozoa associated with cats , mild fever and swollen lymph nodes , HIV with low CD4 listeria monocytogenes cyptococcus neoformans- fungi, HIV and chemotherapy patients

Question 35

confusion, seizures, altered conscious and abnormal behaviour are symptoms of what a. meningitis b. encephalitis c.encephalomeningitis

Answer 35

b. encephalitis

Question 36

which of these encephalitis organisms causes flaccid paralysis ascending from the peripheral nerves to the CNS and causes non severe encephalitis a.mumps b.polio c.rabies

Answer 36

a.mumps

Question 37

which of these encephalitis organisms causes long term disability a.mumps b.polio c.rabies

Answer 37

b.polio

Question 38

which of these encephalitis organisms causes fatality a.mumps b.polio c.rabies

Answer 38

c.rabies

Question 39

what is the most common cause of encephalitis in the UK a.mumps b.polio c.rabies d.herpes simplex

Answer 39

d.herpes simplex

Question 40

headache, fever, irritability , neck stiffness and photophobia indicate what a. meningitis b. encephalitis c.encephalomeningitis

Answer 40

a. meningitis may also have prodromal sore throat

Question 41

what is the characteristic sign of meningococcal septicaemia a.headache b.neck stiffness c.photophobia d.non blanching rash e.blanching rash

Answer 41

d.non blanching rash

Question 42

what is the first thing to do if meningitis is suspected a.give antibiotucs b.imaging c.lumbar puncture d.blood for culture e.throat swabs

Answer 42

a.give antibiotucs

Question 43

in normal adult csf there are....white cells a.some b.no

Answer 43

b.no

Question 44

a high number of neutrophils and high protein count in the csf indicates what a.bacterial infection b.fungal infection c. viral infection d. protozoa infection

Answer 44

a.bacterial infection `(cloudy appearance to csf)

Question 45

high numbers of t lymphocytes and normal protein in the csf indicates what a.bacterial infection b.fungal infection c. viral infection d. protozoa infection

Answer 45

c. viral infection clear appearance to csf

Question 46

what is the first line drug for most cases of bacterial meningitis a.ceftriaxone b.amoxicillin c.cefotaxime d.chloramphenicol

Answer 46

a.ceftriaxone

Question 47

what is added to ceftriaxone (elderly) or cefotaxime (neonates) to cover listeria in bacterial meningitis a. flucloxacillin b.erythromycin c.gentamicin d. amoxicillin

Answer 47

d. amoxicillin

Question 48

what is the first line for bacterial meningitis in neonates a.ceftriaxone b.amoxicillin c.cefotaxime d.chloramphenicol

Answer 48

c.cefotaxime

Question 49

what is added to cefotaxime and amoxicillin in neonates to cover gram negatives a. flucloxacillin b.erythromycin c.gentamicin d. amoxicillin

Answer 49

c.gentamicin

Question 50

what is given for bacterial meningitis if the patient has a life threatening penicillin allergy a.ceftriaxone b.amoxicillin c.cefotaxime d.chloramphenicol

Answer 50

d.chloramphenicol

Question 51

close contacts of those with meningococcal meningitis should be offered prophylaxis with which drug a.ceftriaxone b.amoxicillin c.cefotaxime d.chloramphenicol e.ciprofloxacin

Answer 51

e.ciprofloxacin

Question 52

infective encephalitis is most often cause by a.bacteria b.viruses

Answer 52

b.viruses

Question 53

herpes simplex leading to viral encephalitis is most often due to reactivation of latent virus in the trigeminal ganglia that ascends typically causing infection in which lobes a. temporal b.occipital c. parietal d.temporal

Answer 53

a. temporal

Question 54

what is the key to diagnosing encephalitis a.gram stain b. csf pcr c.imaging d.throat swabs

Answer 54

c.imaging CT MRI can show raised intra cranial pressure which contraindicates a lumbar puncture as it can cause brainstem to be pulled down through foramen magnum (coning)

Question 55

vesicular rashes in encephalitis indicate what cause a.herpes simplex b.mumps c.measles d.eneterovirus meningoencephalitis

Answer 55

a.herpes simplex

Question 56

non vesicular rash in encephalitis is suggestive of what cause a.herpes simplex b.mumps c.measles d.eneterovirus meningoencephalitis

Answer 56

d.eneterovirus meningoencephalitis

Question 57

how is encephalitis disgnosed

Answer 57

scanning PCR from throat, swabs of rash vesicles, blood , lumbar puncture

Question 58

what is used to reduce swelling in encephalitis a.steroids b.antibiotics c.NSAIDs d.diuretics

Answer 58

a.steroids

Question 59

which antiviral is given as the first step of treatment for encephalitis a.ceftriaxone b.amoxicillin c.cefotaxime d.chloramphenicol e.aciclovir

Answer 59

e.aciclovir

Question 60

how is acyclovir given for herpes simples encephalitis a,oral b.ointment c.IV

Answer 60

c.IV

Question 61

which of these drugs competes with deoxyguanosine to be incorporated into the viral DNA stopping viral DNA synthesis a.ceftriaxone b.amoxicillin c.cefotaxime d.chloramphenicol e.aciclovir

Answer 61

e.aciclovir

Question 62

which of these is often a primary infection with HSV a.herpetic gingivostomatitis b.herpes labialis - cold sores

Answer 62

a.herpetic gingivostomatitis

Question 63

in cases of keratoconjunctivitis (HSV eye infection) what should be done a.antibiotic eye drops b.oral antibiotics c.urgent specialist referral d.specialist referral

Answer 63

c.urgent specialist referral

Question 64

what is used topically to treat herpes labialis a.ceftriaxone b.amoxicillin c.cefotaxime d.chloramphenicol e.aciclovir

Answer 64

e.aciclovir

Question 65

what is the secondary infection of varicella known as

Answer 65

shingles varicella = chickenpox

Question 66

what is used for shingles when the patient is immunocompromised; the pain of the infection is severe; the facial dermatomes are involved (branches of the trigeminal nerve which supply sensory supply to the face.) a.ceftriaxone b.amoxicillin c.cefotaxime d.chloramphenicol e.aciclovir

Answer 66

e.aciclovir

Question 67

what is used IV for treatment of cmv infection a.ceftriaxone b.amoxicillin c.ganciclovir d.chloramphenicol e.aciclovir

Answer 67

c.ganciclovir

Question 68

what is used topically for the treatment of herpes keratitis a.ceftriaxone b.amoxicillin c.ganciclovir d.chloramphenicol e.aciclovir

Answer 68

c.ganciclovir

Question 69

what is the main side effect of ganciclovir a.vomiting b.GI upset c.agranulocytosis d. bone marrow suppression

Answer 69

d. bone marrow suppression

Question 70

what is used for prophylaxis of cmv a.ceftriaxone b.valaciclovir c.ganciclovir d.chloramphenicol e.aciclovir

Answer 70

b.valaciclovir given orally

Question 71

who is at specific risk of cmv infection