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CNS Infectious Test 3- 5th Year- PMU

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CNS Infectious Test 3- 5th Year- PMU

Question 1 of 65

1

Which meningitis is characterized by the following CSF findings – lymphocytic pleocytosis, normal or slightly elevated protein and normal glucose level?

Select one of the following:

  • Viral

  • Purulent

  • Tuberculous

Explanation

Question 2 of 65

1

Meningeal irritation includes

Select one of the following:

  • nuchal rigidity, hyperesthesia

  • diminished tendon reflexes

  • altered mental status

Explanation

Question 3 of 65

1

Characteristic clinical manifestation of enteroviral infections is

Select one of the following:

  • Herpagina

  • Gingivostomatitis

  • Exudative pharyngitis

Explanation

Question 4 of 65

1

Which of the following statements regarding enteroviruses as causative agents of aseptic meningitis are NOT TRUE?

Select one of the following:

  • Enteroviruses account for up to 80% of cases of viral meningitis.in children

  • The clinical presentation in children is milder than in adults

  • Lymphocytes are predominant in the first 24 hours, later neutrophils prevail

Explanation

Question 5 of 65

1

Poliomyelitis is characterised by

Select one of the following:

  • flaccid asymmetric, proximal paralysis

  • flaccid symmetric, proximal paralysis

  • full recovery of the affected limb

Explanation

Question 6 of 65

1

The most common causative agents of pyogenic meningitis are

Select one of the following:

  • S.pneumoniae, N. meningitidis, H. influenzae

  • E. coli, S. aureus, Myc. tuberculosis

  • Salmonella spp., L. monocytogenes, St. epidermidis

Explanation

Question 7 of 65

1

Which of the following statements regarding the use of neuroimaging techniques (CT, MRI) in the diagnosis of HSV1 encephalitis are correct?

Select one of the following:

  • Focal lesion in the temporofrontal region is the most common finding

  • CT scanning is the most sensitive neuroimaging technique

  • Diffuse cerebral inflammation is the most common finding

Explanation

Question 8 of 65

1

The causative agents of poliomyelitis are

Select one of the following:

  • Enteroviruses

  • Coronaviruses

  • Paramixoviruses

Explanation

Question 9 of 65

1

Antivirals are used for therapy of

Select one of the following:

  • Enterovirus encephalitis

  • HSV1 encephalitis

  • Japanese encephalitis

Explanation

Question 10 of 65

1

Tetanus is characterised by

Select one of the following:

  • Altered consciousness

  • Intermittent muscle rigidity

  • Constant muscle rigidity and recurring contractions

Explanation

Question 11 of 65

1

Treatment of cerebral oedema includes

Select one of the following:

  • Diuretics — spironolacton

  • Diuretics - mannitol

  • Non-steroidal anti-inflammatory drugs

Explanation

Question 12 of 65

1

40-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?

Select one of the following:

  • Tuberculous meninigitis

  • Cryptoccocal meningitis

  • CNS nocardiosis

Explanation

Question 13 of 65

1

40-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?

Select one of the following:

  • no, microscopy of CSF for AFB will get positive results in 25% of the cases

  • yes, because the are negative

  • no, because AFB will be sought in sputum rather than in CSF

Explanation

Question 14 of 65

1

Which type of meningitis is characterized by the following CSF findings – lymphocytic pleocytosis, elevated protein and decreased glucose level

Select one of the following:

  • viral

  • purulent

  • tuberculous

Explanation

Question 15 of 65

1

The rash of meningococcemia is

Select one of the following:

  • hemorrhagic necrotic, localized predominantly on the lower limbs and buttocks

  • vesicular, diffuse

  • vesicular, highly pruritic

Explanation

Question 16 of 65

1

The specific CNS complication of Chickenpox is

Select one of the following:

  • cerebellitis

  • meningitis serosa

  • polyradiculoneuritis - Guillain-Barre

Explanation

Question 17 of 65

1

Which of the following statements regarding tetanus is correct

Select one of the following:

  • Tetanospamin is an endotoxin that affects motor and sensory function

  • The disease is difficult to clinically differentiate from rabies because of the marked muscle spasm present in both

  • Metronidazole and Penicillin are antibiotics of choice

Explanation

Question 18 of 65

1

A 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?

Select one of the following:

  • Enterovirus

  • Coronavirus

  • HSV-1

Explanation

Question 19 of 65

1

Empirical therapy for bacterial meningitis includes

Select one of the following:

  • 3rd generation Cephalosporins + Vancomycin

  • Penicillin + Metronidazole

  • 3rd generation Cephalosporins + Clindamycin

Explanation

Question 20 of 65

1

Serotherapy (antibodies based medications) is used for

Select one of the following:

  • Rabies

  • Tetanus

  • HSV1 encephalitis

Explanation

Question 21 of 65

1

Which of the following statements regarding leptospirosis IS NOT true

Select one of the following:

  • Leptospirosis is a biphasic illness with multiorgan involvement

  • Gentamycin is the antibiotic of choice

  • Infection is acquired during walking or bathing in rivers

Explanation

Question 22 of 65

1

Which of the following ARE NOT common clinical manifestations of HSV1 encephalitis

Select one of the following:

  • Drowsiness

  • Personality change

  • Diarrhoea

Explanation

Question 23 of 65

1

A 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?

Select one of the following:

  • N. meningitis B

  • S. pneumonia

  • H. influenzae

Explanation

Question 24 of 65

1

A 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?

Select one of the following:

  • the vaccine is not immunogenic enough

  • N. meningitis b is not included in the vaccine

  • the vaccine is not properly administrated

Explanation

Question 25 of 65

1

Which meningitis is characterized by the following CSF findings — neutrophilic pleocytosis, elevated protein and decreased glucose level?

Select one of the following:

  • Viral

  • Purulent

  • Tuberculous

Explanation

Question 26 of 65

1

A 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?

Select one of the following:

  • E.coli and Str. agalactiae

  • H. influenzae and N. meningitis

  • H. influenzae and S. pneumoniae

Explanation

Question 27 of 65

1

The majority of nonimmunized patients infected with poliovirus would be expected to experience which of the following symptoms

Select one of the following:

  • Aseptic meningitis

  • Flaccid paralysis of one or more extremities

  • Asymptomatic infection

Explanation

Question 28 of 65

1

Which of the following findings IS NOT characteristic of infant meningitis

Select one of the following:

  • Bulging fontanelle, Lessage sign

  • Distended abdomen

  • Cri encephalique

Explanation

Question 29 of 65

1

Meningeal irritation, prolonged and severe mental status impairment and focal neurological findings are common in

Select one of the following:

  • Meningoencephalitis

  • Encephalitis

  • Meningitis

Explanation

Question 30 of 65

1

Poliomyelitis is characterized by a

Select one of the following:

  • Flaccid asymmetric paralysis, proximal

  • Flaccid symmetric paralysis, proximal

  • Full recovery of the affected limb

Explanation

Question 31 of 65

1

Which patient with suspected bacterial meningitis should undergo CT of the head prior to lumbar puncture?

Select one of the following:

  • Infants

  • Those with focal neurological findings

  • It is a rule for every patient

Explanation

Question 32 of 65

1

Typical clinical manifestations of enterovirus infections are

Select one of the following:

  • Herpangina

  • Gingivostomatitis

  • Pneumonia

Explanation

Question 33 of 65

1

A 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?

Select one of the following:

  • Arboviral encephalitis

  • VZV encephalitis

  • HSV encephalitis

Explanation

Question 34 of 65

1

A 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?

Select one of the following:

  • Acyclovir

  • Ganoyclovir

  • Zanamivir

Explanation

Question 35 of 65

1

Which meningitis is characterized by cranial nerves palsies, CSF — with low glucose level and without response to empirical antibiotic therapy

Select one of the following:

  • Tuberculous

  • Purulent

  • Viral

Explanation

Question 36 of 65

1

Which diseases in not vaccine preventable

Select one of the following:

  • Lyme borreliosis

  • Poliomyelitis

  • Measles

Explanation

Question 37 of 65

1

The antibiotic of choice in treating diphtheria is

Select one of the following:

  • erythromycin - stops toxin production and eradicate shedding

  • quinolones

  • gentamicin

Explanation

Question 38 of 65

1

Strawberry tongue is characteristic of Ex which disease: - also in Kawasaki's disease

Select one of the following:

  • Scarlet fever

  • Measles

  • Chickenpox

Explanation

Question 39 of 65

1

Which disease requires antítoxin serum as a first urgent step in the management of the patient

Select one of the following:

  • measles

  • diphtheria

  • necrotizing fasciitis

Explanation

Question 40 of 65

1

The desquamation is a characteristic, albeit a late one, of which of the diseases

Select one of the following:

  • Measles

  • Scarlet fever

  • Impetigo

Explanation

Question 41 of 65

1

Invasive infection with Streptecoccus pyogenes is a severe complication of

Select one of the following:

  • Chickenpox

  • Prolonged hospitalization

  • EBV infection

Explanation

Question 42 of 65

1

Chickenpox rash is characterized by

Select one of the following:

  • maculae-papules-vesicles-crasts, in various stages of healing. - rashes appears in crops so have different healing

  • vesicular rash ina. dermatomal distribution - seen in shingles reinfection

  • maculae-papules-vesicles- pustulles- scabs, all in the same stage of development

Explanation

Question 43 of 65

1

Which virus has teratogenic effect in the first trimester of pregnancy

Select one of the following:

  • Rubella

  • Enteroviruses

  • Measles

Explanation

Question 44 of 65

1

A 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

Select one of the following:

  • ELISA for HIV

  • HIV 24 antigen

  • VCA IgM for EBV

Explanation

Question 45 of 65

1

Which disease is vaccine preventable?

Select one of the following:

  • Scarlet fever

  • Measles

  • Exanthema subitum

Explanation

Question 46 of 65

1

Which of the following statements is typical for pharyngeal diphtheria

Select one of the following:

  • creamy bulky patches, firmly attached to the underlying tissues

  • whitish patches on the tonsils and buccal mucosa, easily removable

  • dirty gray patches, adherent to the. underlying tissues, spreading across the tonsils

Explanation

Question 47 of 65

1

In a case of infectious mononucleosis-like symptoms it is important to consider

Select one of the following:

  • primary HIV infection

  • neoplasms

  • syphilis

Explanation

Question 48 of 65

1

A 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?

Select one of the following:

  • Infectious mononucleosis

  • Retropharyngeal abscess

  • Diphtheria

Explanation

Question 49 of 65

1

A 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?

Select one of the following:

  • ceftriaxone

  • aggressive rehydration

  • antitoxin

Explanation

Question 50 of 65

1

Fill the blank spaces to complete the text.

A 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 given as part of the immunisation schedules with appropriate given. The close contacts should be tested and given a course of the vaccine also

Explanation

Question 51 of 65

1

The common complication of Chickenpox is

Select one of the following:

  • Cerebellitis

  • Meningitis serosa

  • Poliradiculonevrtis- Guillain Barre type

Explanation

Question 52 of 65

1

Tonsillitis, caused by EBV (Infectious mononucleosis) should be differentiated from

Select one of the following:

  • Diphteria

  • Necrotic angina

  • Streptococcal angina

Explanation

Question 53 of 65

1

The rash of meningococcemia is

Select one of the following:

  • hemorhagic-necrotic, localized predominantly in the lower limbs and the buttocks

  • vesicular, with diffuse localization

  • hives, variable

Explanation

Question 54 of 65

1

Which of the following statements concerning the Varicella-Zoster-Virus (VZV) infection is true?

Select one of the following:

  • Infant whose mother was ill with Herpes Zoster one week after birth, is at risk of severe neonatal varicella and should receive VZV immunoglobulin

  • most life-threatening complication of chickenpox during pregnancy is pneumonia

  • congenital varicella syndrome usually occurs in infants whose mothers have suffered from Chicken pox late in pregnancy

Explanation

Question 55 of 65

1

The rash of Measles is

Select one of the following:

  • maculopapular, confluent

  • vesiculopustular on intact skin

  • hemorrhagic, necrotic with irregular shapes and different sizes

Explanation

Question 56 of 65

1

The evolution of the rash of Chickenpox is

Select one of the following:

  • macula-papule-vesicle-crust

  • macula-papule-brown pigmentation

  • petechiae ecchymosis, suffusion

Explanation

Question 57 of 65

1

Pregnant in the 2nd LM has moprbilliform rash and negative serological test (RZHA) for Rubella
What is the next step?

Select one of the following:

  • Therapeutic abortion by medical indications

  • Ribavirin therapy

  • Repeating the test after 3 weeks

Explanation

Question 58 of 65

1

The late complications of Scarlet fever the most often are

Select one of the following:

  • carditis, glomerulonephritis, synovitis

  • meningitis or encephalitis

  • mastoiditis, sinusitis or otitis

Explanation

Question 59 of 65

1

Typical for Diphtheria are

Select one of the following:

  • thick, dirty gray, removable hard deposits on the tonsils

  • whitish easily removable deposits on the tonsils and buccal mucosa

  • disease is widespread in Bulgaria

Explanation

Question 60 of 65

1

Which is NOT true of heterophile antibodies and Infectious mononucleosis?

Select one of the following:

  • in a typical clinical manifestation they are sufficient to confirm the diagnosis

  • in typical clinical manifestation with negative heterophile antibodies we are looking for antibodies to Ebstein-Bar virus

  • heterophile bodies are formed in mononucleosis caused by CMV

Explanation

Question 61 of 65

1

Patients With Chickenpox are contagious

Select one of the following:

  • 3 days after the onset

  • until the dropping of the crusts

  • until drying of all vesicles

Explanation

Question 62 of 65

1

A 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

Select one of the following:

  • C. Diptheria

  • Streptococcus Group A

  • Erysipelothrix rhusiopathiae

Explanation

Question 63 of 65

1

A 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

Select one of the following:

  • Asphyxia

  • Resorption the toxin, and impairment of peripheral nerves adjacent

  • Myocarditis

Explanation

Question 64 of 65

1

A 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?

Select one of the following:

  • antibiotic

  • oxygen, corticosteroids, ready for intubations / tracheotomy

  • antitoxin serum

Explanation

Question 65 of 65

1

A 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

Select one of the following:

  • anaphylaxis

  • serum sickness

  • paresis

Explanation

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