Infectious Disease

QUESTIONS

1. A 25-year-old female presents to the clinic with neck stiffness, fever, and headache. She is found to have aseptic meningitis. Which one of the following is most likely the cause?

A. Lyme disease

B. Sarcoidosis

C. Coxsackievirus

D. Adenovirus

E. None of the above

View Answer

1. Answer: C. Coxsackie viruses and echoviruses (types of enteroviruses) account for about half of the cases of aseptic meningitis. The others can cause aseptic meningitis but are not as common.

2. A 45-year-old female with a history of AIDS develops encephalopathy. Which one of the following is the most common cause for encephalopathy in AIDS patients?

A. Toxoplasmosis

B. Herpes

C. Medication side effects

D. Staphylococcus aureus

E. None of the above

View Answer

2. Answer: A. Toxoplasmosis along with PML and HIV encephalopathy are the three most common causes for encephalopathy in AIDS patients.

3. A 29-year-old male with a history of AIDS is diagnosed with progressive multifocal leukoencephalopathy (PML). Which of the following is true?

A. PML damages white matter of the brain including U-fibers.

B. PML is diagnosed only by brain biopsy.

C. Polymerase chain reaction (PCR) for the John Cunningham (JC) virus shows high specificity.

D. Highly active antiretroviral therapy (HAART) has not shown benefit for AIDS patients.

E. None of the above

View Answer

3. Answer: C. PCR for the JC virus has high specificity for diagnosing the disease and therefore can usually replace the need for brain biopsy.

4. A 45-year-old male who recently traveled to South Korea is found to have a headache, encephalopathy, and an acute infection with brucellosis. Which of the following is another possible neurologic complication?

A. Bell’s palsy

B. Trigeminal neuralgia

C. Exophthalmos

D. Sensorineural hearing loss

E. None of the above

View Answer

4. Answer: D. Sensorineural hearing loss is the second most common focal neurologic side effect of brucellosis after encephalopathy. Most symptoms of brucellosis are nonfocal or non-specific symptoms such as headache, fever, and malaise.

5. Which of the following is the most common virus associated with neonatal herpes encephalitis?

A. Human herpesvirus-6 (HHV-6)

B. Herpes simplex virus-1 (HSV-1)

C. Human immunodeficiency virus (HIV)

D. Human T-cell lymphotropic virus (HTLV-1)

E. Herpes simplex virus-2 (HSV-2)

View Answer

5. Answer: E. HSV-1 is the more common cause of adult encephalitis. HSV-2 is the more common cause of newborn encephalitis, which is associated with maternal genital infections.

6. Patients treated for herpes encephalitis often have neurologic sequelae. Which one of the following is the most common sequelae?

A. Hemiparesis

B. Developmental delay

C. Seizures

D. Stroke

E. Hematoma

View Answer

6. Answer: C. Seizures are the most common neurologic sequelae; approximately 44% of patients go on to develop epilepsy. It is associated with developmental delay in approximately 25% of patients. Despite adequate therapy, patients still have poor long-term neurologic outcome.

7. Prior to effective immunizations, which one of the following was one of the most common causes of bacterial meningitis but is currently seen much less often and rarely occurs in children over age 5?

A. Neisseria meningitidis

B. Streptococcus pneumoniae

C. Escherichia coli

D. Listeria monocytogenes

E. Haemophilus influenzae

View Answer

7. Answer: E. Haemophilus influenzae type b (Hib) has been identified as one of the three most common causes of bacterial meningitis. The others are Neisseria meningitidis and Streptococcus pneumoniae. These three bacteria have accounted, before the development of effective immunizations, for more than 80% of all cases of meningitis in industrialized nations. Prior to effective immunizations, Hib has been the most important cause of meningitis in children younger than 5 years of age. Since immunization, the frequency has reduced significantly.

8. A 34-year-old male complaining of muscle pain is found to have pyomyositis. What is the most likely location of his abscess?

A. Psoas

B. Quadriceps

C. Biceps

D. Triceps

E. All of the above

View Answer

8. Answer: B. The quadriceps is the most common location of pyomyositis. The psoas is the second most common location.

9. Which one of the following is the most common neurologic manifestation of acute Lyme disease?

A. Cranial neuropathy

B. Meningitis

C. Cerebritis

D. Radiculopathy

E. Myositis

View Answer

9. Answer: A. Cranial neuropathies are the most common neurologic presentation. The others are associated but are not as common. Approximately 5% to 10% of untreated patients with Lyme disease have signs of cranial neuropathies, and up to 60% of patients with early Lyme disease develop cranial neuritis. It usually begins 3 weeks after infection. Seventh nerve palsy is by far the most common. Bilateral facial palsy can be seen in 35% of patients.

10. A 54-year-old male from Connecticut presents with a rash and history of tick bite. What percentage of patients with Lyme disease have erythema migrans at the site of the tick bite?

A. 5%

B. 25%

C. 50%

D. 90%

E. None of the above

View Answer

10. Answer: D. About 90% of patients develop the classic expanding rash at the site of the tick bite. Erythema migrans starts as a flat to slightly raised erythematous lesion at the site of the tick bite within days to weeks. Over days, the lesion spreads to a diameter of approximately 5 to 6 inches. The center of the bite may clear, giving this lesion its typical bull’s-eye appearance or target lesion.

Only gold members can continue reading. Log In or Register to continue