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CNS Infectious Test 3- 5th Year- PMU
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Questions in this quiz (65)
1Which meningitis is characterized by the following CSF findings – lymphocytic pleocytosis, normal or slightly elevated protein and normal glucose level?
- AViral
- BPurulent
- CTuberculous
2Meningeal irritation includes
- Anuchal rigidity, hyperesthesia
- Bdiminished tendon reflexes
- Caltered mental status
3Characteristic clinical manifestation of enteroviral infections is
- AHerpagina
- BGingivostomatitis
- CExudative pharyngitis
4Which of the following statements regarding enteroviruses as causative agents of aseptic meningitis are NOT TRUE?
- AEnteroviruses account for up to 80% of cases of viral meningitis.in children
- BThe clinical presentation in children is milder than in adults
- CLymphocytes are predominant in the first 24 hours, later neutrophils prevail
5Poliomyelitis is characterised by
- Aflaccid asymmetric, proximal paralysis
- Bflaccid symmetric, proximal paralysis
- Cfull recovery of the affected limb
6The most common causative agents of pyogenic meningitis are
- AS.pneumoniae, N. meningitidis, H. influenzae
- BE. coli, S. aureus, Myc. tuberculosis
- CSalmonella spp., L. monocytogenes, St. epidermidis
7Which of the following statements regarding the use of neuroimaging techniques (CT, MRI) in the diagnosis of HSV1 encephalitis are correct?
- AFocal lesion in the temporofrontal region is the most common finding
- BCT scanning is the most sensitive neuroimaging technique
- CDiffuse cerebral inflammation is the most common finding
8The causative agents of poliomyelitis are
- AEnteroviruses
- BCoronaviruses
- CParamixoviruses
9Antivirals are used for therapy of
- AEnterovirus encephalitis
- BHSV1 encephalitis
- CJapanese encephalitis
10Tetanus is characterised by
- AAltered consciousness
- BIntermittent muscle rigidity
- CConstant muscle rigidity and recurring contractions
11Treatment of cerebral oedema includes
- ADiuretics — spironolacton
- BDiuretics - mannitol
- CNon-steroidal anti-inflammatory drugs
1240-year old man was admitted to the ED because of progressive worsening headache and drooping right eyelid for the last 6 hours. Over the last week he felt uneasy, with throbbing headache, vomited twice. On presentation he was alert, T-37,4°C, with normal vital signs, mild nuchal rigidity, right n. abducens palsy, the remainder of physical examination was without abnormalities. His CXR showed a right apical opacity and ipsilateral hilar lymphadenopathy.
Below are the results of the CSF examination and Gram stain:
Appearance - turbid
Cells- 159.10^6/l (90% neutrophils)
Protein- 1.2 g/l
Glucose- 1,5 mmol/l (blood glucose — 5,9 mmol/l)
Gram stain- no bacteria seen
Acid-fast stain- no bacteria seen
Cryptococcus antigen- negative
Culture- no bacterial growth
Mycobacteria PCR- genus negative/ M. tuberculosis complex negative
Mycobacteria culture- continuing
Which specific infection needs to be considered in this clinical setting?- ATuberculous meninigitis
- BCryptoccocal meningitis
- CCNS nocardiosis
1340-year old man was admitted to the ED because of progressive worsening headache and drooping right eyelid for the last 6 hours. Over the last week he felt uneasy, with throbbing headache, vomited twice. On presentation he was alert, T-37,4°C, with normal vital signs, mild nuchal rigidity, right n. abducens palsy, the remainder of physical examination was without abnormalities. His CXR showed a right apical opacity and ipsilateral hilar lymphadenopathy.
Below are the results of the CSF examination and Gram stain:
Appearance - turbid
Cells- 159.10^6/l (90% neutrophils)
Protein- 1,2 g/l
Glucose- 1,5 mmol/l (blood glucose — 5,9 mmol/l)
Gram stain- no bacteria seen
Acid-fast stain- no bacteria seen
Cryptococcus antigen- negative
Culture- no bacterial growth
Myeobacteria PCR- genus negative/ M. tuberculosis complex negative
Mycobacteria culture- continuing
Do the results of microscopy rule out this diagnosis?- Ano, microscopy of CSF for AFB will get positive results in 25% of the cases
- Byes, because the are negative
- Cno, because AFB will be sought in sputum rather than in CSF
14Which type of meningitis is characterized by the following CSF findings – lymphocytic pleocytosis, elevated protein and decreased glucose level
- Aviral
- Bpurulent
- Ctuberculous
15The rash of meningococcemia is
- Ahemorrhagic necrotic, localized predominantly on the lower limbs and buttocks
- Bvesicular, diffuse
- Cvesicular, highly pruritic
16The specific CNS complication of Chickenpox is
- Acerebellitis
- Bmeningitis serosa
- Cpolyradiculoneuritis - Guillain-Barre
17Which of the following statements regarding tetanus is correct
- ATetanospamin is an endotoxin that affects motor and sensory function
- BThe disease is difficult to clinically differentiate from rabies because of the marked muscle spasm present in both
- CMetronidazole and Penicillin are antibiotics of choice
18A 4 year-old girl presents with a macularpapular rash on her hands and feet and painful ulcers distributed anteriorly on her lips , tongue, palate and buccal mucosa. Systemic features and lymphadenopathy are absent. Which of the following viruses is most likely to have caused these disorder?
- AEnterovirus
- BCoronavirus
- CHSV-1
19Empirical therapy for bacterial meningitis includes
- A3rd generation Cephalosporins + Vancomycin
- BPenicillin + Metronidazole
- C3rd generation Cephalosporins + Clindamycin
20Serotherapy (antibodies based medications) is used for
- ARabies
- BTetanus
- CHSV1 encephalitis
21Which of the following statements regarding leptospirosis IS NOT true
- ALeptospirosis is a biphasic illness with multiorgan involvement
- BGentamycin is the antibiotic of choice
- CInfection is acquired during walking or bathing in rivers
22Which of the following ARE NOT common clinical manifestations of HSV1 encephalitis
- ADrowsiness
- BPersonality change
- CDiarrhoea
23A 19-year-old freshman, living in a dormitory accommodation, took to his bed early one Friday evening, complaining of a flu-like illness and headache. The next morning he was found unresponsive with a widespread non-blanching rash. He was taken to the ED. Physical examination revealed unresponsive patient with signs of meningeal irritation, T-39,5°C,blood pressure 120/70 mmHg, heart rate 100 beat/min. A lumbar puncture was done after CT scan.
Below are the results of the CSF examination and Gram stain:
Appearance - turbid
Cells - 800.10^6/l, neutrophils
Glucose — 0.5 mmol/l (blood glucose - 7,0 mmol/l)
Gram stain — no bacteria seen
The whole freshman year had received a meningococcal vaccine prior to starting their course
What do your think is the cause of this infection?- AN. meningitis B
- BS. pneumonia
- CH. influenzae
24A 19-year-old freshman, living in a dormitory accommodation, took to his bed early one Friday evening, complaining of a flu-like illness and headache. The next morning he was found unresponsive with a widespread non-blanching rash. He was taken to the ED. Physical examination revealed unresponsive patient with signs of meningeal irritation, T-39,5°C,blood pressure 120/70 mmHg, heart rate 100 beat/min. A lumbar puncture was done after CT scan.
Below are the results of the CSF examination and Gram stain:
Appearance - turbid
Cells - 800.10^6/l, neutrophils
Glucose — 0.5 mmol/l (blood glucose - 7,0 mmol/l)
Gram stain — no bacteria seen
The whole freshman year had received a meningococcal vaccine prior to starting their course
Why was he not protected by the vaccine?- Athe vaccine is not immunogenic enough
- BN. meningitis b is not included in the vaccine
- Cthe vaccine is not properly administrated
25Which meningitis is characterized by the following CSF findings — neutrophilic pleocytosis, elevated protein and decreased glucose level?
- AViral
- BPurulent
- CTuberculous
26A 3-week-old boy developed focal seizures, lethargy and vomiting. Examination shows a bulging fontanelle and nuchal rigidity. Which of the following organisms should be suspected?
- AE.coli and Str. agalactiae
- BH. influenzae and N. meningitis
- CH. influenzae and S. pneumoniae
27The majority of nonimmunized patients infected with poliovirus would be expected to experience which of the following symptoms
- AAseptic meningitis
- BFlaccid paralysis of one or more extremities
- CAsymptomatic infection
28Which of the following findings IS NOT characteristic of infant meningitis
- ABulging fontanelle, Lessage sign
- BDistended abdomen
- CCri encephalique
29Meningeal irritation, prolonged and severe mental status impairment and focal neurological findings are common in
- AMeningoencephalitis
- BEncephalitis
- CMeningitis
30Poliomyelitis is characterized by a
- AFlaccid asymmetric paralysis, proximal
- BFlaccid symmetric paralysis, proximal
- CFull recovery of the affected limb
31Which patient with suspected bacterial meningitis should undergo CT of the head prior to lumbar puncture?
- AInfants
- BThose with focal neurological findings
- CIt is a rule for every patient
32Typical clinical manifestations of enterovirus infections are
- AHerpangina
- BGingivostomatitis
- CPneumonia
33A 45-year-old man was brought to the ED by his wife after a new onset of seizure. He had been well until 48 hours prior when he had the abrupt onset of fever and headache . Over the next 2 days he exhibited bizarre behaviour. On physical examination he was minimally responsive without nuchal rigidity or focal neurological findings. A CT scan of the head showed diffuse inflammatory changes, greates in the left temporal lobe. Blood laboratory results - unremarkable .
Below are the results of the CSF examination and Gram stain
Appearance - turbid
Erythrocytes- 700. 10^6/l
Cells - 43.10^6/l, lymphocyte predominance
Protein- 0.7 g/l
Glucose- normal
Gram stain- no bacteria seen
What is the diagnosis likely to be?- AArboviral encephalitis
- BVZV encephalitis
- CHSV encephalitis
34A 45-year-old man was brought to the ED by his wife after a new onset of seizure. He had been well until 48 hours prior when he had the abrupt onset of fever and headache . Over the next 2 days he exhibited bizarre behaviour. On physical examination he was minimally responsive without nuchal rigidity or focal neurological findings. A CT scan of the head showed diffuse inflammatory changes, greates in the left temporal lobe. Blood laboratory results - unremarkable .
Below are the results of the CSF examination and Gram stain
Appearance - turbid
Erythrocytes- 700. 10^6/l
Cells - 43.10^6/l, lymphocyte predominance
Protein- 0.7 g/l
Glucose- normal
Gram stain- no bacteria seen
What antimicrobial agent need to be considered?- AAcyclovir
- BGanoyclovir
- CZanamivir
35Which meningitis is characterized by cranial nerves palsies, CSF — with low glucose level and without response to empirical antibiotic therapy
- ATuberculous
- BPurulent
- CViral
36Which diseases in not vaccine preventable
- ALyme borreliosis
- BPoliomyelitis
- CMeasles
37The antibiotic of choice in treating diphtheria is
- Aerythromycin - stops toxin production and eradicate shedding
- Bquinolones
- Cgentamicin
38Strawberry tongue is characteristic of Ex which disease: - also in Kawasaki's disease
- AScarlet fever
- BMeasles
- CChickenpox
39Which disease requires antítoxin serum as a first urgent step in the management of the patient
- Ameasles
- Bdiphtheria
- Cnecrotizing fasciitis
40The desquamation is a characteristic, albeit a late one, of which of the diseases
- AMeasles
- BScarlet fever
- CImpetigo
41Invasive infection with Streptecoccus pyogenes is a severe complication of
- AChickenpox
- BProlonged hospitalization
- CEBV infection
42Chickenpox rash is characterized by
- Amaculae-papules-vesicles-crasts, in various stages of healing. - rashes appears in crops so have different healing
- Bvesicular rash ina. dermatomal distribution - seen in shingles reinfection
- Cmaculae-papules-vesicles- pustulles- scabs, all in the same stage of development
43Which virus has teratogenic effect in the first trimester of pregnancy
- ARubella
- BEnteroviruses
- CMeasles
44A 21-old male presented to ED with 2 weeks of low-grade fevers, fatigue. and myalgias. O/P - alert, pharyngeal erythema without exudate. a painful ulcer on the right buccal mucose, cervical lymphadenopahy and a fine erythematous macular rash on his upper chest. He reported he was sexually active with both men and women. Which test should be used to confirm your suspicion
- AELISA for HIV
- BHIV 24 antigen
- CVCA IgM for EBV
45Which disease is vaccine preventable?
- AScarlet fever
- BMeasles
- CExanthema subitum
46Which of the following statements is typical for pharyngeal diphtheria
- Acreamy bulky patches, firmly attached to the underlying tissues
- Bwhitish patches on the tonsils and buccal mucosa, easily removable
- Cdirty gray patches, adherent to the. underlying tissues, spreading across the tonsils
47In a case of infectious mononucleosis-like symptoms it is important to consider
- Aprimary HIV infection
- Bneoplasms
- Csyphilis
48A 5-year-old girl recently immigrated with her parents to the USA a month ago presented with low-grade fever, bloody nasal discharge, and extensive neck swelling. Her immunization record was not available. She was difficult to understand because of the language barrier; but she seemed to be having difficulty breathing. O/P in distress, T 38.3°C. RR 40/min, HR 140/min, PR 90/60 mm, swollen neck, oropharynx - dense greyish-white membranes spreading across the tonsils and covering uvula and soft palate.
What is the most likely diagnosis?- AInfectious mononucleosis
- BRetropharyngeal abscess
- CDiphtheria
49A 5-year-old girl recently immigrated with her parents to the USA a month ago presented with low-grade fever, bloody nasal discharge, and extensive neck swelling. Her immunization record was not available. She was difficult to understand because of language barrier; but she seemed to be having difficulty breathing. O/P in distress, T 38,3°C. RR 40/min, HR 140/min, PR 90/60 mm, swollen neck, oropharynx - dense greyish-white membranes spreading across the tonsils and covering uvula and soft palate.
What should be the next step in the management of the patient?- Aceftriaxone
- Baggressive rehydration
- Cantitoxin
50A 5-year-old girl recently immigrated with her parents to the USA a month ago presented with low-grade fever, bloody nasal discharge, and extensive neck swelling. Her immunization record was not available. She was difficult to understand because of language barrier; but she seemed to be having difficulty breathing. O/P in distress, T 38,3°C. RR 40/min, HR 140/min, PR 90/60 mm, swollen neck, oropharynx - dense greyish-white membranes spreading across the tonsils and covering uvula and soft palate.
How this severe medical condition should have been prevented?
It could be prevented with a diphtheria toxoid containing [blank_start]vaccine (DTP, DTaP)[blank_end] given as part of the immunisation schedules with appropriate [blank_start]boosters[blank_end] given. The close contacts should be tested and given a [blank_start]booster[blank_end] course of the vaccine also- Avaccine (DTP, DTaP)
- Bbooster
- Cboosters
51The common complication of Chickenpox is
- ACerebellitis
- BMeningitis serosa
- CPoliradiculonevrtis- Guillain Barre type
52Tonsillitis, caused by EBV (Infectious mononucleosis) should be differentiated from
- ADiphteria
- BNecrotic angina
- CStreptococcal angina
53The rash of meningococcemia is
- Ahemorhagic-necrotic, localized predominantly in the lower limbs and the buttocks
- Bvesicular, with diffuse localization
- Chives, variable
54Which of the following statements concerning the Varicella-Zoster-Virus (VZV) infection is true?
- AInfant whose mother was ill with Herpes Zoster one week after birth, is at risk of severe neonatal varicella and should receive VZV immunoglobulin
- Bmost life-threatening complication of chickenpox during pregnancy is pneumonia
- Ccongenital varicella syndrome usually occurs in infants whose mothers have suffered from Chicken pox late in pregnancy
55The rash of Measles is
- Amaculopapular, confluent
- Bvesiculopustular on intact skin
- Chemorrhagic, necrotic with irregular shapes and different sizes
56The evolution of the rash of Chickenpox is
- Amacula-papule-vesicle-crust
- Bmacula-papule-brown pigmentation
- Cpetechiae ecchymosis, suffusion
57Pregnant in the 2nd LM has moprbilliform rash and negative serological test (RZHA) for Rubella
What is the next step?- ATherapeutic abortion by medical indications
- BRibavirin therapy
- CRepeating the test after 3 weeks
58The late complications of Scarlet fever the most often are
- Acarditis, glomerulonephritis, synovitis
- Bmeningitis or encephalitis
- Cmastoiditis, sinusitis or otitis
59Typical for Diphtheria are
- Athick, dirty gray, removable hard deposits on the tonsils
- Bwhitish easily removable deposits on the tonsils and buccal mucosa
- Cdisease is widespread in Bulgaria
60Which is NOT true of heterophile antibodies and Infectious mononucleosis?
- Ain a typical clinical manifestation they are sufficient to confirm the diagnosis
- Bin typical clinical manifestation with negative heterophile antibodies we are looking for antibodies to Ebstein-Bar virus
- Cheterophile bodies are formed in mononucleosis caused by CMV
61Patients With Chickenpox are contagious
- A3 days after the onset
- Buntil the dropping of the crusts
- Cuntil drying of all vesicles
62A 2-year-old child was having fever from 5-6 days as well as dry cough and hoarse voice, From the day before he came his skin was turning blue after coughing, his voice became almost silent and he also became very restless. He was brought to the Emergency center. Clinical status: impaired condition, acrocyanosis. temperature to 38,6°C. visibly swollen cervical lymph nodes. View of the throat revealed edema pharynx, dirty gray shiny deposits covering the tonsils, uvula and soft palate, the child cried soundless voice inspiratory tachydyspnea- 40/min, breathing was shallow with a circulation, without audible wheezing, heart rate - 158/ min. The remaining objective examination was normal.
The most likely diagnosis is- AC. Diptheria
- BStreptococcus Group A
- CErysipelothrix rhusiopathiae
63A 2-year-old child was having fever from 5-6 days as well as dry cough and hoarse voice, From the day before he came his skin was turning blue after coughing, his voice became almost silent and he also became very restless. He was brought to the Emergency center. Clinical status: impaired condition, acrocyanosis. temperature to 38,6°C. visibly swollen cervical lymph nodes. View of the throat revealed edema pharynx, dirty gray shiny deposits covering the tonsils, uvula and soft palate, the child cried soundless voice inspiratory tachydyspnea- 40/min, breathing was shallow with a circulation, without audible wheezing, heart rate - 158/ min. The remaining objective examination was normal.
The danger, in this case, is determined from- AAsphyxia
- BResorption the toxin, and impairment of peripheral nerves adjacent
- CMyocarditis
64A 2-year-old child was having fever from 5-6 days as well as dry cough and hoarse voice, From the day before he came his skin was turning blue after coughing, his voice became almost silent and he also became very restless. He was brought to the Emergency center. Clinical status: impaired condition, acrocyanosis. temperature to 38,6°C. visibly swollen cervical lymph nodes. View of the throat revealed edema pharynx, dirty gray shiny deposits covering the tonsils, uvula and soft palate, the child cried soundless voice inspiratory tachydyspnea- 40/min, breathing was shallow with a circulation, without audible wheezing, heart rate - 158/ min. The remaining objective examination was normal.
What does the most urgent treatment in case involve?- Aantibiotic
- Boxygen, corticosteroids, ready for intubations / tracheotomy
- Cantitoxin serum
65A 2-year-old child was having fever from 5-6 days as well as dry cough and hoarse voice, From the day before he came his skin was turning blue after coughing, his voice became almost silent and he also became very restless. He was brought to the Emergency center. Clinical status: impaired condition, acrocyanosis. temperature to 38,6°C. visibly swollen cervical lymph nodes. View of the throat revealed edema pharynx, dirty gray shiny deposits covering the tonsils, uvula and soft palate, the child cried soundless voice inspiratory tachydyspnea- 40/min, breathing was shallow with a circulation, without audible wheezing, heart rate - 158/ min. The remaining objective examination was normal.
The most dangerous side effects due to serum were- Aanaphylaxis
- Bserum sickness
- Cparesis
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- CNS Infectious Test 3- 5th Year- PMU
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- Med Student
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- Created on 22 Apr 2020 · updated on 9 Jun 2020
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