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Adams 10th > Chapter 32 - Infections of the nervous system (bacterial, fungal, spirochetal, parasitic) > Flashcards

Chapter 32 - Infections of the nervous system (bacterial, fungal, spirochetal, parasitic) Flashcards

1
Q 
Most common cause of bacterial meningitis in unvaccinated children
A. Streptococcus pneumoniae
B. Neisseria meningitidis
C. Haemophilus influenzae
D. Escherichia coli
E. Group B streptococcus
F. Staphylococcus
A

C. Haemophilus influenzae (p. 697)

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2
Q 
Most common cause of bacterial meningitis in post-neurosurgical patients
A. Streptococcus pneumoniae
B. Neisseria meningitidis
C. Haemophilus influenzae
D. Escherichia coli
E. Group B streptococcus
F. Staphylococcus
A

F. Staphylococcus (p. 698)

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3
Q 
Which among the following is the reason for development of blindness and optic atrophy as a late effect or sequelae of bacterial meningitis?*
A. Antibiotic toxicity
B. Recurrence of infection
C. Optochiasmatic arachnoiditis
D. Chronic meningoencephalitis
A

C. Optochiasmatic arachnoiditis (p. 699)

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4
Q

Which aspect of bacterial meningitis produces focal seizures?*
A. Pia-arachnoiditis
B. Subpial encephalopathy
C. Inflammatory or vascular involvement of cranial nerve roots
D. Thrombosis of meningeal veins
E. Hydrocephalus

A

D. Thrombosis of meningeal veins (p. 699)

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5
Q

Which aspect of acute bacterial meningitis produces signs of meningeal irritation such as the Kernig and Brudzinski signs?
A. Pia-arachnoiditis
B. Subpial encephalopathy
C. Inflammatory or vascular involvement of cranial nerve roots
D. Thrombosis of meningeal veins
E. Ependymitis
F. Cerebellar or cerebral hemisphere herniation

A

A. Pia-arachnoiditis (p. 699)

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6
Q

Which aspect of acute bacterial meningitis produces deafness?
A. Pia-arachnoiditis
B. Subpial encephalopathy
C. Inflammatory or vascular involvement of cranial nerve roots
D. Thrombosis of meningeal veins
E. Ependymitis
F. Cerebellar or cerebral hemisphere herniation

A

C. Inflammatory or vascular involvement of cranial nerve roots (p. 699)

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7
Q

Which aspect of acute bacterial meningitis produces confusion, stupor, coma, and convulsions?
A. Pia-arachnoiditis
B. Subpial encephalopathy
C. Inflammatory or vascular involvement of cranial nerve roots
D. Thrombosis of meningeal veins
E. Ependymitis
F. Cerebellar or cerebral hemisphere herniation

A

B. Subpial encephalopathy (p. 699)

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8
Q

Which aspect of acute bacterial meningitis produces focal cerebral deficits?
A. Pia-arachnoiditis
B. Subpial encephalopathy
C. Inflammatory or vascular involvement of cranial nerve roots
D. Thrombosis of meningeal veins
E. Ependymitis
F. Cerebellar or cerebral hemisphere herniation

A

D. Thrombosis of meningeal veins (p. 699)

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9
Q

Which aspect of acute bacterial meningitis produces upper cervical cord or midbrain-third-nerve compression?
A. Pia-arachnoiditis
B. Subpial encephalopathy
C. Inflammatory or vascular involvement of cranial nerve roots
D. Thrombosis of meningeal veins
E. Ependymitis
F. Cerebellar or cerebral hemisphere herniation

A

F. Cerebellar or cerebral hemisphere herniation (p. 699)

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10
Q 
Which aspect of subacute and chronic meningitis results to impaired alertness in a child, refusal to eat, vomiting, immobility, bulging fontanels, and persistence of fever despite clearing of CSF?
A. Hydrocephalus
B. Subdural effusion
C. Venous infarction
D. Arterial infarction
A

B. Subdural effusion (p. 699)

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11
Q

Which late effect or sequelae of bacterial meningitis results to dementia, paralysis, and sometimes, a tabetic syndrome?
A. Meningomyelitis
B. Chronic meningoencephalitis and hydrocephalus
C. Persistent hydrocephalus
D. None of the above

A

B. Chronic meningoencephalitis and hydrocephalus (p. 699)

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12
Q 
Pathogenic organism that is usually associated with brain/epidural abscess, head trauma, neurosurgical procedures, or cranial thrombophlebitis*
A. S. pneumoniae
B. S. pyogenes
C. Listeria
D. Pseudomonas
A

B. S. pyogenes (p. 700)

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13
Q 
Evolution is rapid; onset is attended by petechial or purpuric rash or by large ecchymoses and lividity of the skin of the lower body; circulatory shock; local outbreaks
A. Meningococcal meningitis
B. Pneumococcal meningitis
C. H. influenzae meningitis
D. Staphylococcal meningitis
A

A. Meningococcal meningitis (p. 701)

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14
Q 
Preceded by infection in the lungs, ears, sinuses, or heart valves; seen in alcoholics, splenectomized patients, elderly, dermal sinus tracts, sickle cell anemia, and basal skull fracture
A. Meningococcal meningitis
B. Pneumococcal meningitis
C. H. influenzae meningitis
D. Staphylococcal meningitis
A

B. Pneumococcal meningitis (p. 701)

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15
Q 
Follows URTI and ear infections in the uninoculated child
A. Meningococcal meningitis
B. Pneumococcal meningitis
C. H. influenzae meningitis
D. Staphylococcal meningitis
A

C. H. influenzae meningitis (p. 701)

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16
Q

Meningitis in the presence of furunculosis or following a neurosurgical procedure
A. Streptococcus pneumoniae
B. N. meningitidis
C. Coagulase-positive staphylococcus (S. aureus)
D. Coagulase-negative staphylococcus (S. epidermidis)

A

C. Coagulase-positive staphylococcus (S. aureus) (p. 701)

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17
Q

Meningitis associated with ventricular shunts or drains
A. Streptococcus pneumoniae
B. N. meningitidis
C. Coagulase-positive staphylococcus (S. aureus)
D. Coagulase-negative staphylococcus (S. epidermidis)

A

D. Coagulase-negative staphylococcus (S. epidermidis) (p. 701)

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18
Q 
Focal cerebral signs in the early stages of meningitis are most frequent in
A. Pneumococcal meningitis
B. H. influenzae meningitis
C. Both A and B
D. None of the above
A

C. Both A and B (p. 701)

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19
Q 
Seizures are encountered most often with
A. Pneumococcal meningitis
B. H. influenzae meningitis
C. Both A and B
D. None of the above
A

B. H. influenzae meningitis (p. 701)

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20
Q 
Cranial nerve abnormalities are particularly frequent with
A. Pneumococcal meningitis
B. H. influenzae meningitis
C. Both A and B
D. None of the above
A

A. Pneumococcal meningitis (p. 701)

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21
Q 
Most significant factor in the pathogenesis of neonatal meningitis
A. Premature birth
B. Prolonged labor
C. Premature rupture of membranes
D. Maternal infection
A

D. Maternal infection (p. 701)

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22
Q 
Substantial hemorrhage or substantial numbers of RBCS in the CSF are commonly seen in meningoencephalitis due to*
A. Mycoplasma
B. Legionella
C. Bartonella
D. Listeria
E. Anthrax
A

E. Anthrax (p. 702)

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23
Q

Patients are classified as very low risk for bacterial meningitis if they lack all of the following criteria EXCEPT
A. Positive CSF Gram stain
B. CSF ANC of at least 1000 cells/mL
C. CSF protein of at least 80 mg/dL
D. Peripheral ANC of at least 10000 cells/mL
E. History of seizure before the time of presentation

A

E. History of seizure before the time of presentation (p. 703)

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24
Q

Which of the following is true about bacterial meningitis?*
A. There is a rise in total LDH activity because of fractions 4 and 5, which are derived from granulocytes
B. There is a rise in total LDH activity because of fractions 4 and 5, which are derived from bacteria
C. LDH 1 and 2 are derived from brain tissue and are found to be low
D. None of the above

A

A. There is a rise in total LDH activity because of fractions 4 and 5, which are derived from granulocytes (p. 703)

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25
Q 
Most specific and sensitive test for CSF leak*
A. CSF glucose
B. CSF protein
C. Beta2-transferrin
D. Litmus test
A

C. Beta2-transferrin (p. 704)

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26
Q 
Recurrent oropharyngeal mucosal ulceration, uveitis, orchitis, and meningitis
A. EBV infection
B. Behcet disease
C. Mollaret meningitis
D. Vogt-Koyanagi-Harada syndrome
A

B. Behcet disease (p. 704)

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27
Q 
Recurrent episodes of fever and headache in addition to signs of meningeal irritation, in many cases caused by herpes simplex
A. EBV infection
B. Behcet disease
C. Mollaret meningitis
D. Vogt-Koyanagi-Harada syndrome
A

C. Mollaret meningitis (p. 704)

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28
Q 
Recurrent meningitis associated with iridocyclitis and depigmentation of the hair and skin (poliosis and vitiligo)
A. EBV infection
B. Behcet disease
C. Mollaret meningitis
D. Vogt-Koyanagi-Harada syndrome
A

D. Vogt-Koyanagi-Harada syndrome (p. 704)

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29
Q

Empiric therapy of bacterial meningitis EXCEPT*
A. Neonates: gentamycin plus amikacin
B. Infants: third generation cephalosporin plus ampicillin plus dexamethasone
C. Immunocompetent adult: ceftriaxone plus vancomycin
D. Immunocompromised: ceftazidime plus vancomycin plus ampicillin
E. Post-neurosurgical procedure: ceftazidime plus vancomycin

A

A. Neonates: gentamycin plus amikacin (p. 705)

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30
Q 
Which drug should be added to the regimen in cases of suspected Listeria meningitis?
A. Cefotaxime
B. Ampicillin
C. Ceftazidime
D. Vancomycin
E. Dexamethasone
A

B. Ampicillin (p. 705)

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31
Q

Which of the following is true of corticosteroids in children with bacterial meningitis?*
A. Corticosteroids decrease mortality
B. Corticosteroids lead to a decrease in incidence of sensorineural deafness and other neurologic sequelae
C. Corticosteroids are administered to decrease cerebral edema
D. None of the above

A

B. Corticosteroids lead to a decrease in incidence of sensorineural deafness and other neurologic sequelae (p. 706)

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32
Q

Prophylaxis for meningococcal meningitis*
A. Ciprofloxacin 500 mg OD x 7 days
B. Rifampin 600 mg q12 for 2 days
C. There is no need for prophylaxis if 1 week has elapsed since the index case was found
D. There is no need for prophylaxis beyond 150 meters from exposure to index case

A

B. Rifampin 600 mg q12 for 2 days (p. 707)

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33
Q 
Components of the Osler triad EXCEPT
A. Coma
B. Pneumococcal meningitis
C. Pneumonia
D. Endocarditis
A

A. Coma (p. 707)

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34
Q 
Bacterial meningitis with bacteremia, hypotension, brain swelling, and cerebellar herniation are more frequently due to*
A. S. pneumoniae
B. H. influenzae
C. E. coli
D. Staphylococcus
A

A. S. pneumoniae (p. 707)

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35
Q 
Which of the following bacterial etiologies of encephalitis can cause GBS, cranial neuritis, acute myositis, aseptic meningitis, transverse myelitis, seizures, and cerebellitis?*
A. Mycoplasma
B. Listeria
C. Legionella
D. Bartonella
E. Anthrax
A

A. Mycoplasma (p. 708)

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36
Q 
Infection caused by this bacteria usually takes the form of a rhombencephalitis
A. Mycoplasma
B. Listeria
C. Legionella
D. Bartonella
E. Anthrax
A

B. Listeria (p. 709)

37
Q 
Infection with this bacteria must be suspected in returning travelers from India and Southeast Asia (particularly Cambodia and Thailand) who develop encephalitis
A. Mycoplasma
B. Listeria
C. Burkholderia pseudomallei
D. Legionella
E. Bartonella
F. Anthrax
A

C. Burkholderia pseudomallei (p. 709)

38
Q 
Suspicion of the disease caused by this bacteria is based on exposure or on the presence of an atypical pneumonia
A. Mycoplasma
B. Listeria
C. Burkholderia pseudomallei
D. Legionella
E. Bartonella
F. Anthrax
A

D. Legionella (p. 709)

39
Q 
The illness caused by this bacteria begins as unilateral axillary or cervical adenopathy and has been implicated in causing a focal cerebral vasculitis in AIDS patients as well as neuroretinitis
A. Mycoplasma
B. Listeria
C. Burkholderia pseudomallei
D. Legionella
E. Bartonella
F. Anthrax
A

E. Bartonella (p. 710)

40
Q 
This bacteria causes a rare form of meningoencephalitis that is seen in abattoir workers or people from the Middle East who ingest raw milk
A. Mycoplasma
B. Listeria
C. Legionella
D. Bartonella
E. Anthrax
F. Brucella
A

F. Brucella (p. 710)

41
Q 
Fairly specific for this disease is a rhythmic myoclonus or spasm occurring in synchronous bursts involving several adjacent regions, mainly the eyes, jaw, and face
A. Listeria
B. Legionnaire's disease
C. Catscratch disease
D. Anthrax
E. Brucellosis
F. Whipple disease
A

F. Whipple disease (p. 710)

42
Q

Which of the following is NOT true about subdural empyema?*
A. Subdural empyema is not the same as subdural abscess.
B. Thrombosis of the underlying cortical veins is common.
C. The spinal fluid is often sterile, but on occasion an organism is cultured.
D. The treatment is always surgical followed by a 2-week course of antibiotics

A

D. The treatment is always surgical followed by a 2-week course of antibiotics (p. 712)

43
Q 
Subdural empyema may be caused by spread from septic thrombosis of the venous sinuses, particularly which sinus?
A. Superior longitudinal sinus
B. Transverse sinus
C. Straight sinus
D. Confluence of sinuses
A

A. Superior longitudinal sinus (p. 711)

44
Q 
Most common congenital heart disease implicated in brain abscesses
A. Tetralogy of Fallot
B. Patent foramen ovale
C. ASD
D. VSD
A

A. Tetralogy of Fallot (p. 715)

45
Q 
Organism implicated in brain abscesses due to accidental or surgical trauma, sometimes endocarditis, and especially in drug addicts who inject themselves
A. Streptococci
B. Enterobacteriaceae
C. Staphylococci
D. Candida
A

C. Staphylococci (p. 715)

46
Q 
Most common organisms causing bacterial cerebral abscess
A. Streptococci
B. Enterobacteriaceae
C. Staphylococci
D. Candida
A

A. Streptococci (p. 715)

47
Q 
Organism causing brain abscess that is almost always associated with otitic infections
A. Streptococci
B. Enterobacteriaceae
C. Staphylococci
D. Candida
A

B. Enterobacteriaceae (p. 715)

48
Q 
Organism causing brain abscess that are commonly metastatic from the lung and paranasal sinuses
A. Streptococci
B. Enterobacteriaceae
C. Staphylococci
D. Candida
A

A. Streptococci (p. 715)

49
Q 
Most frequent initial symptom of intracranial abscess
A. Headache
B. Drowsiness and confusion
C. Seizure
D. Focal motor/sensory deficits
E. Speech disorders
A

A. Headache (p. 716)

50
Q 
Tuberculous meningitis which occurs after NS procedures and cranial trauma is usually attributed to
A. M. tuberculosis
B. M. bovis
C. M. avian
D. M. kansasii
E. M. fortuitum
A

E. M. fortuitum (p. 718)

51
Q 
Organisms that cause persistent polymorphonuclear pleocytosis in CSF EXCEPT
A. M. tuberculosis
B. Nocardia
C. Aspergillus
D. Actinomyces
E. None of the above
A

E. None of the above (p. 719)

52
Q

Imaging findings in TB meningitis EXCEPT
A. One or more tuberculomas may be visualized
B. There may be deep cerebral infarcts
C. MRA or CTA may demonstrate vascular occlusive disease
D. None of the above

A

D. None of the above (p. 719)

53
Q 
Single most effective drug agains TB meningitis
A. Isoniazid
B. Rifampin
C. Ethambutol
C. Pyrazinamide
A

A. Isoniazid (p. 721)

54
Q 
This anti-TB drug's most important adverse effects are neuropathy and hepatitis, particularly in alcoholics
A. Isoniazid
B. Rifampin
C. Ethambutol
C. Pyrazinamide
A

A. Isoniazid (p. 721)

55
Q 
This anti-TB drug may cause optic neuropathy
A. Isoniazid
B. Rifampin
C. Ethambutol
C. Pyrazinamide
A

C. Ethambutol (p. 721)

56
Q 
This anti-TB drug's main adverse effects are rash, GI disturbances, and hepatitis
A. Isoniazid
B. Rifampin
C. Ethambutol
C. Pyrazinamide
A

C. Pyrazinamide (p. 721)

57
Q

Which of the following is NOT TRUE about the use of corticosteroids in TB meningitis?
A. Corticosteroids may be used in patients whose lives are threatened by the effects of raised ICP.
B. Corticosteroids are used only in conjunction with anti-TB drugs.
C. Dexamethasone 0.4 mg/kg daily for a week and then tapering doses for 3-6 weeks reduces mortality among TB meningitis patients.
D. Corticosteroids reduced the chances of residual disability among TB meningitis patients.

A

D. Corticosteroids reduced the chances of residual disability among TB meningitis patients. (p. 721)

58
Q 
Most common manifestation of neurosarcoidosis*
A. Myopathy
B. Hydrocephalus
C. Facial palsy
D. Polyradiculopathy
E. Nodular masses
A

C. Facial palsy (p. 722)

59
Q 
Initial event in neurosyphilis*
A. Asymptomatic meningitis
B. Meningovascular meningitis
C. Tabes dorsalis
D. Transverse myelitis
A

A. Asymptomatic meningitis (p. 723)

60
Q 
Which of the following is not a principal type of neurosyphilis?*
A. Tabes dorsalis
B. Meningovascular meningitis
C. Weil's syndrome
D. Dementia paralytica
E. Spinal syphilis
A

C. Weil’s syndrome (pp. 725-728)

61
Q 
It is now probably the most common form of neurosyphilis
A. Asymptomatic neurosyphilis
B. Meningeal syphilis
C. Meningovascular syphilis
D. Paretic neurosyphilis
E. Tabetic neurosyphilis
A

C. Meningovascular syphilis (p. 725)

62
Q 
Main manifestation of secondary syphilis
A. Asymptomatic neurosyphilis
B. Meningeal syphilis
C. Meningovascular syphilis
D. Paretic neurosyphilis
E. Tabetic neurosyphilis
A

C. Meningovascular syphilis (p. 725)

63
Q

Treatment for neurosyphilis
A. Penicillin G 18-24 M units IV q4h for 10-14 days
B. Penicillin G 3-4 M units IV q4h for 10-14 days
C. Penicillin G 3-4 M units IM q4h for 10-14 days
D. Penicillin G 3-4 M units IV q4h for 7-10 days

A

B. Penicillin G 3-4 M units IV q4h for 10-14 days (p. 728)

64
Q

True of flucytosine for cryptococcal meningitis*
A. Addition of flucytosine to amphotericin B results in fewer failures or relapses
B. Amphotericin B is given at 0.7-1.0 mg/kg/d when flucytosine is added
C. Flucytosine + amphotericin B is given for less than 6 weeks
D. None of the above

A

A. Addition of flucytosine to amphotericin B results in fewer failures or relapses (p. 732)

65
Q 
Percentage of persistent sensorineural hearing loss among children with pneumococcal meningitis*
A. 31%
B. 10.5%
C. 6%
D. 50%
A

A. 31% (p. 708)

66
Q 
Most frequent opportunistic fungal infection
A. Candidiasis
B. Aspergillosis
C. Mucormycosis
D. Coccidiodomycosis
A

A. Candidiasis (p. 732)

67
Q 
Presents as osteomyelitis at the base of the skull
A. Candidiasis
B. Aspergillosis
C. Mucormycosis
D. Coccidiodomycosis
A

B. Aspergillosis (p. 732)

68
Q 
Presents as proptosis, ophthalmoplegia, edema of the lids and retina, and hemorrhagic infarction of the brain
A. Candidiasis
B. Aspergillosis
C. Mucormycosis
D. Coccidiodomycosis
A

C. Mucormycosis (p. 733)

69
Q 
Usually causes only a benign, influenza-like illness with pulmonary infiltrates
A. Candidiasis
B. Aspergillosis
C. Mucormycosis
D. Coccidiodomycosis
A

D. Coccidiodomycosis (p. 733)

70
Q 
Which of the following does NOT cause a persistent polymorphonuclear pleocytosis?
A. TB
B. Nocardiosis
C. Actinomycosis
D. Histoplasmosis
A

D. Histoplasmosis (p. 733)

71
Q 
Which of the following rickettsial diseases is transmitted from lice to humans and person to person?*
A. Epidemic typhus
B. Endemic typhus
C. Scrub typhus
D. Rocky Mountain Spotted Fever
E. Q fever
A

A. Epidemic typhus (p. 733)

72
Q 
Which of the following rickettsial diseases is transmitted from fleas from rats to humans?
A. Epidemic typhus
B. Endemic typhus
C. Scrub typhus
D. Rocky Mountain Spotted Fever
E. Q fever
A

B. Endemic typhus (p. 733)

73
Q 
Which of the following rickettsial diseases is transmitted from mites from rodents/humans?
A. Epidemic typhus
B. Endemic typhus
C. Scrub typhus
D. Rocky Mountain Spotted Fever
E. Q fever
A

C. Scrub typhus (p. 733)

74
Q 
Which of the following rickettsial diseases is transmitted from ticks?
A. Epidemic typhus
B. Endemic typhus
C. Scrub typhus
D. Rocky Mountain Spotted Fever
E. Q fever
A

D. Rocky Mountain Spotted Fever (p. 733)

75
Q 
Which of the following rickettsial diseases is transmitted from ticks or inhalation of dust and handling of materials infected by the causative organism?
A. Epidemic typhus
B. Endemic typhus
C. Scrub typhus
D. Rocky Mountain Spotted Fever
E. Q fever
A

E. Q fever (p. 733)

76
Q 
Which of the following rickettsial diseases presents with a necrotic ulcer or eschar at the site of attachment of the infected mite?
A. Epidemic typhus
B. Endemic typhus
C. Scrub typhus
D. Rocky Mountain Spotted Fever
E. Q fever
A

C. Scrub typhus (pp. 733-734)

77
Q 
Which of the following rickettsial diseases is NOT associated with an exanthem?
A. Epidemic typhus
B. Endemic typhus
C. Scrub typhus
D. Rocky Mountain Spotted Fever
E. Q fever
A

E. Q fever (p. 734)

78
Q 
Most common cause of focal cerebral lesions in patients with AIDS
A. TB
B. Neurosyphilis
C. Cryptococcosis
D. Toxoplasmosis
A

D. Toxoplasmosis (p. 734)

79
Q

Which of the following is true regarding treatment for CNS toxoplasmosis in patients with AIDS?*
A. Leucovirin is added to the regimen to counteract the antifolate action of sulfadiazine
B. Treatment at lower doses is continued until CD4 count exceeds 200-250 for 6 months or more
C. Treatment at usual doses must be given lifelong
D. None of the above

A

B. Treatment at lower doses is continued until CD4 count exceeds 200-250 for 6 months or more (p. 735)

80
Q 
What are the expected CSF findings in cerebral malaria?*
A. Parasitized RBCs
B. Increased pressure
C. Significant leukocytosis
D. Low sugar
E. Increased protein
A

B. Increased pressure (p. 736)

81
Q 
Posterior cervical lymphadenopathy highly characteristic of CNSI with trypanosoma
A. Durck sign
B. Winterbottom sign
C. Kerandel sign
D. Chagas sign
A

B. Winterbottom sign (p. 736)

82
Q 
Which of the following parasites does NOT cause seizures?*
A. Taenium
B. Trichinella
C. S. japonicum
D. Toxoplasma
E. Entamoeba histolytica
A

B. Trichinella (Table 32-6 p. 737)

83
Q 
Third generation cephalosporins are NOT indicated in the treatment of meningitis due to which organism?*
A. Streptococcus pneumoniae
B. Neisseria meningitidis
C. Listeria monocytogenes
D. E. coli
E. H. influenzae
A

C. Listeria monocytogenes (Table 32-4, p. 707)

84
Q

Which of the following is NOT true regarding the use of corticosteroids in the treatment of TB meningitis?*
A. Reduces mortality
B. Reduces residual disability
C. Used in patients whose lives are threatened by effects of subarachnoid block or raised ICP
D. All of the above are true

A

B. Reduces residual disability (p. 721)

85
Q 
Which of the following diseases best characterizes a patient who develops chronic sinusitis, multiple craniopathies, hemorrhagic infarctions, and basal skull osteomyelitis?*
A. Syphilis
B. HIV
C. Mucormycosis
D. TB
E. Aspergillosis
A

E. Aspergillosis (p. 732)

86
Q

A patient with HIV presented with MRI findings of multiple rim-enhancing masses. What is the best way to proceed with the case?*
A. Give oral sulfadiazine + pyrimethamine until CD4 count exceeds 200-250 for 6 months, if not, treatment is given lifelong
B. Brain biopsy is needed for definitive treatment
C. Give oral sulfadiazine + pyrimethamine for 2-4 weeks
D. Request for MR spectroscopy of the brain

A

A. Give oral sulfadiazine + pyrimethamine until CD4 count exceeds 200-250 for 6 months, if not, treatment is given lifelong (p. 735)

87
Q

Chemosis, proptosis, and edema of the ipsilateral eyelids, forehead, and nose in septic cavernous sinus thrombophlebitis is due to*
A. Direct infection of the cranial nerves and affected facial muscles
B. Obstruction of the ophthalmic veins
C. Inflammatory infiltrates in the affected areas
D. None of the above

A

B. Obstruction of ophthalmic veins (p. 713)

88
Q

Nigrovic and colleagues have developed a clinical prediction rule that classifies patients at very low risk for bacterial meningitis if they lack all of the following criteria EXCEPT*
A. Positive CSF Gram stain
B. CSF ANC of at least 1000 cells/mL
C. CSF protein of at least 1000 mg/dL
D. Peripheral ANC of at least 10000 cells/mL
E. History of seizure at or after the time of presentation

A

C. CSF protein of at least 1000 mg/dL (p. 703)

Adams 10th (27 decks)

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