DIMITRI P. AGAMANOLIS, M. D. Akron Childrens Hospital NorthEastern Ohio Universities College of Medicine Neuropathology
TEST-CHAPTER FIVE
CNS INFECTIONS
Questions marked with * are more appropriate for residents.
1. A natural epidural space exists around
a. The brain
b. The spinal cord
c. Both
d. Neither
2. The most common cause of subdural empyema is:
a. Open trauma
b. Meningitis
c. Osteomyelitis
d. Sinusitis
3. A 50 year old patient was admitted to the hospital with a hemorrhagic rash, a temperature of 40C, and shock. He was treated with antibiotics but died in 3 hours. The best way establish the diagnosis in this case is:
a. Bacterial culture
b. Postmortem PCR for bacteria
c. Latex studies
d. Gram stains
4.Which is more likely to develop one week after the onset of untreated bacterial meningitis?
a. Ischemic infarcts
b. Subarachnoid hemorrhage
c. Deafness
d. Hydrocephalus
e. Hypoxic-ischemic encephalopathy
5. Which of the following is most common among the following complications of meningitis?
a. Cerebritis
b. Brain abscess
c. Ventriculitis
d. Subdural abscess
6. The most dangerous feature of an abscess is:
a. Sepsis
b. Loss of neurological function
c. Increased intracranial pressure
d. Development of meningitis
*7. CNS syphilis causes all of the following except:
a. Ischemic lesions
b. Suppurative meningitis
c. Radiculopathy and myelopathy
d. Mass-like lesions
8. A 3 year old boy presents to the ER in mid September with a history of diarrhea, headache and obtundation. A spinal tap is done. The most appropriate studies are:
a. RT-PCR
b. PCR and RT-PCR
c. Bacterial cultures, PCR and RT-PCR
d. The patient can be safely observed for 24 hours
9. The most common cause of brain damage in HIV encephalitis is:
a. Opportunistic infections
b. Cerebral lymphoma
c. HIV infection of neurons
d. Cytokines and viral toxins.
10. Most CJD is:
a. Familial
b. Sporadic
c. Transmitted from animals
d. Iatrogenic
11. The most frequent source of iatrogenic CJD is:
a. Pituitary extracts
b. Dura transplants
c. Contaminated electrodes
d. Transfusions
*12. Are there prion protein gene mutations in sporadic CJD?
a. Yes
b. No
13. Familial prion diseases are:
a. Autosomal dominant
b. Autosomal recessive
c. Both
d. Sporadic
14. Meningitis usually crosses the pial barrier and involves the brain
a. True
b. False
*15. A 15 year old boy was admitted to the hospital with a hemorrhagic rash, temperature of 40C and shock. He was treated with antibiotics but died 5 hours later. The autopsy showed:
a. Meningitis
b. Inflammation of thechoroid plexus
c. Microthrombi in pulmonary vessels and hemorrhagic adrenals
d. All of the above
*16. A 36 year old AIDS patient had fever, headaches, and neurological deficits. MRI showed multiple enhancing brain lesions. A stereotactic biopsy of one lesion was done. The findings are consistent with:
toxoplasmosis
a. A DNA virus infection
b. A protozoan infection
c. A fungal infection
d. Primary HIV pathology
*17. Which of the statements about spinal cord pathology in HIV infection is not true?
a. Spinal cord lesions in AIDS may be caused by HSV2 myelitis.
b. Spongy myelinopathy in the spinal cord is causedby HIV.
c. The lesions have some similarity to tropical myeloneuropathy.
d. The pathology resembles motor neuron disease.
18. Animal prion diseases occur naturally in the US
a. True
b. False
*19. A 6 day old baby developed sepsis, hypotonia, respiratory insufficiency, and died. The autopsy revealed the brain stem (left) and spinal cord (right) lesions shown below. The most likely diagnosis is:
Poliomyelitis Poliomyelitis
a. Congenital CMV infection
b. Congenital HSV infection
c. Congenital Coxsackie infection
d. Congenital toxoplasmosis
20. The lesion illustrated below may be caused by:
HIV encephalitis
a. A DNA virus
b. A retrovirus
c. A mycobacterium
d. CJD
21. The pathology shown below most likely represents:
CJD
a. Cryptococcal infection
b. HIV encephalitis
c. A prion infection
d. Clostridial infection
*22. The CSF in a patient with the lesion illustrated below shows:
Tuberculosis
a. No organisms, few lymphocytes, normal protein, and normal glucose
b. Fungal hyphae and yeasts, acute unflammation,increased protein, decreased glucose
c. Acid fast organisms, lymphocytes, increased protein, decreased glucose
d. Gram positive organisms, neutrophils, increased protein, decreased glucose
*23. The lesions illustrated below are caused by:
Cryptococcosis
a. Fungi with yeasts and hyphae
b. Fungi with yeasts
c. Fungi with branching septate hyphae
d. Postmortem bacterial overgrowth
24. The lesion illustrated below is caused by:
Viral intranuclear inclusion
a. DNA virus
b. Retrovirus
c. Enterovirus
d. All of the above
25. The lesion illustrated below is caused by:
Herpes simplex encephalitis
a. Trauma
b. Ruptured anterior communicating aneurysm
c. A DNA virus
d. Cerebral malaria
*26. A 60 year old patient presented with fever, headaches, seizures and hemorrhagic CSF. MRI showed a left frontotemporal lesion with edema. The biopsy of the hemorrhagic lesion is shown below. The diagnosis can be best obtained by:
HSV encephalitis
a. Bacterial culture
b. Viral PCR
c. Fluorescent antibody studies
d. ELISA test
27. The lesions below are caused by:
congenital CMV
a. Congenital toxoplasmosis.
b Congenital HSV.
c. Congenital CMV.
d Congenital varicella zoster virus
28. The most likely cause of the pathology in the 59 year old patient illustrated below is:
Meningitis
a. Meningococcus
b. Pneumococcus
c. Haemophilus influenzae
d. E. Coli