CNS

Question 1

Methods for HSV Encephalitis diagnosis

Answer 1

EEG
MRI
Brain biopsy
CSF analysis with PCR

Question 2

EEG findings in HSV encephalitis

Answer 2

periodic lateralizing epileptiform discharges

Question 3

Diagnosis of VZV encephalitis

Answer 3

send CSF PCR and antibodies
PCR has low sensitivity

Question 4

MR findings in VZV encephalitis

Answer 4

large vessel vasculitis and ischemia

Question 5

Steroid indication with VZV encephalitis

Answer 5

if there is evidence of vasculopathy

Question 6

HHV-6 encephalitis treatment

Answer 6

Ganciclovir or Foscarnet

Question 7

MR findings in CMV encephalitis

Answer 7

subependymal gadolinium enchancement and non specific white matter changes

Question 8

CMV encephalitis treatment

Answer 8

Ganciclovir and foscarnet

Question 9

Three features of severe WNV

Answer 9

meningitis
encephalitis/meningoencephalitis
poliomyelitis with flaccid paralysis

Question 10

Diagnosis of WNV

Answer 10

serum IgM antibody
CSF IgM
PCR CSF sensitivity less than 60%

Question 11

Unique presenting feature of St Louis Encephalitis Virus

Answer 11

urinary symptoms, SIADH

Question 12

Diagnosis of SLEV

Answer 12

Serology, CSF IgM

Question 13

Clinical features of Japanese Encephalitis Virus

Answer 13

Seizures and parkinsonian features, poliomyelitis like flaccid paralysis

Question 14

Classic patient population for JEV

Answer 14

children, rice field association

Question 15

powassan virus vector

Answer 15

ixodes scapularis tick

Question 16

clinical features of powassan virus

Answer 16

Parkinsonism, involvement of basal ganglia and thalamus

Question 17

Tick borne encephalitis virus location

Answer 17

eastern Russia, central Europe

Question 18

Tickborne encephalitis virus risks

Answer 18

unpasteurized milk or cheeses, SOT, rituximab

Question 19

Tickborne encephalitis presentation

Answer 19

poliomyelitis like paralysis

Question 20

PEP for Tickborne encephalitis

Answer 20

anti-TBE Immune globulin

Question 21

eastern equine encephalitis virus feature of CSF

Answer 21

high WBC count >1000 with neutrophilic predominance

Question 22

incubation period of rabies

Answer 22

20-90 days

Question 23

rabies clinical presentation

Answer 23

encephalitic form
paralytic form

Question 24

features off encephalitic rabies

Answer 24

agitation with alternating lucidity
hyper salivation
hydrophobia
bizarre behavior
progression to coma, death

Question 25

features of rabies paralytic form

Answer 25

ascending paralysis, early muscle weakness later cerebral involvement

Question 26

association with NMDAR encephalitis

Answer 26

OVarian teratoma check TVUS

Question 27

association with NMDAR encephalitis

Answer 27

HSV encephalitis and later development of NMDAR antibodies

Question 28

therapy for NMDAR encephalitis

Answer 28

Steroids, IVIG, PLEX Rituximab or cyclophosphamide

Question 29

possible presentation of enterovirus 71

Answer 29

rhomboencephalitis ataxia, myoclonus, CN deficits

Question 30

suppressive therapy role in recurrent HSV 2 meningitis

Answer 30

not indicated, associated with higher frequency of meningitis after cessation of drug

Question 31

animals that transmit lymphocytic choriomeningitis virus

Answer 31

rats, rodents, mice, hamsters more common in winter

Question 32

association with enteric GN meningitis

Answer 32

disseminated strongyloidiasis in hyper infection syndrome

Question 33

empiric therapy < 1 month

Answer 33

ampicillin, gentamicin, cefotaxime or cefepime

Question 34

empiric therapy of meningitis 1-23 months

Answer 34

vancomycin plus 3rd gen ceph

Question 35

empiric therapy 2-50

Answer 35

vanc plus 3rd gen ceph

Question 36

older than 50

Answer 36

vanc, ampicillin, 3rd gen ceph

Question 37

basilar skull fracture empiric therapy

Answer 37

vanc and 3rd gen ceph

Question 38

head trauma, neurosurgery, CSF shunt empiric therapy

Answer 38

vancomycin plus cefepime/ceftazidime/meropenem

Question 39

MIC cut off to use penicillin for pneumococcus

Answer 39

< or equal to .06

Question 40

PCN MIC < 1 pneumococcus therapy

Answer 40

3rd generation ceph

Question 41

PCN MIC 1 or greater pneumococcus therapy

Answer 41

vanc and 3rd generation ceph

Question 42

Neisseria PCM MIC <1

Answer 42

penicillin or ampicillin

Question 43

Neisseria MIC .1 to 1

Answer 43

3rd generation cephalosporin

Question 44

H flu B lactase negative

Answer 44

ampicillin

Question 45

H flu B lactamase positive

Answer 45

3rd generation cephalosporin

Question 46

clinical feature of listeria meningitis

Answer 46

increased risk of seizures and focal neurologic signs

Question 47

possible clinical presentation of listeria

Answer 47

rhombencephalitis late development of ataxia, nystagmus and cranial nerve palsies

Question 48

patient presenting with Gram Negative Meningitis. what is a possible risk for this

Answer 48

seen with strongyloides hyper infection syndrome

Question 49

duration of treatment for listeria meningitis

Answer 49

21 days

Question 50

duration of treatment for Neisseria meningitis

Answer 50

7 d

Question 51

duration of treatment for E coli meningitis

Answer 51

21 d

Question 52

what is the most common cause of viral meningitis

Answer 52

enterovirus

Question 53

lymphocytic choriomeningitis virus risk factors

Answer 53

rodent infested houses lab personnel pet owners