Acute meningitis
1. 28-year-old African woman with 2-week history of headaches and lethargy. Diagnosed with HIV infection 3 years ago but not treated. CSF 30 WBC (lymphocytes), glucose 3.4 mmol/l (blood glucose 6.9), protein 1.5 g/l, Gram stain, stain for AFB negative. India ink staining shows large organisms surrounded by halo.

Cryptococcus neoformans
Mycobacterium tuberculosis
Neisseria meningitidis
Echovirus
Haemophilus influenzae type B

2. 56-year-old man in the Medical Admissions Unit has been unwell for one week with increasing headaches and fever. Now become confused and incontinent of urine. Has neck stiffness and a right 3rd nerve palsy. CT brain scan is normal. CSF shows 460 WBC (90% lymphocytes), glucose 2.3 mmol/l (blood glucose 13.7) protein 2.5 g/l, Gram stain and stains for AFB and India ink stain are negative.

Haemophilus influenzae type B
Neisseria meningitidis
Mycobacterium tuberculosis
Echovirus
Cryptococcus neoformans

3. Which of the following is an amoeba that can cause meningitis?

Treponema pallidum
Cryptococcus neoformans
Naeglaria fowleri
Salmonella enterica
Herpes simplex

4. 30-year-old woman unwell for 48 hours with severe headache, neck pain and fever. She has neck stiffness, positive Kernig's sign and photophobic. CSF shows 89 WBC (90% lymphocytes), glucose 3.2 mmol/l (blood glucose 5.9), protein 0.5 g/l, Gram stain negative.

Echovirus
Neisseria meningitidis
Streptococcus pneumoniae
Cryptococcus neoformans
Haemophilus influenzae type B

5. Intracellular Gram-negative diplococci

Neisseria meningitidis
Mycobacterium tuberculosis
Strep. pneumoniae
Cryptococcus neoformans
Haemophilus influenzae

6. 45-year-old man had an ear infection treated with erythromycin 8 days ago. Brought to A&E with increasing confusion and headache. Had a short-lived grand mal convulsion. He has neck stiffness, his left ear is discharging purulent material. CT brain scan is normal, CSF shows cloudy fluid, 3000 WBC (85% neutrophils), glucose 0.8 g/l (blood glucose 8.9), protein 1.8 g/l, Gram stain show Gram-positive diplococci.

Neisseria meningitidis
Echovirus
Streptococcus pneumoniae
Cryptococcus neoformans
Haemophilus influenzae type B

7. A gram-positive, catalase-negative cause of meningitis.

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
Cryptococcus neoformans
Naeglaria fowleri

8. Pathogenesis of meningitis; Entry of bacteria through defect in the dura, e.g.

meningococcal
pneumococcus
echovirus infection

9. Which of the following is the least common cause of meningitis?

Pneumococcus
Meningococcus
Klebsiella
Listeria monocytogenes
Haemophilus influenzae

10. Pathogenesis of meningitis; Infection during viraemic phase of viral infections, e.g.

pneumococcus
meningococcal
echovirus infection

11. 18-year-old student in A&E with confusion, high fever and neck stiffness. On examination she has a sparse non-blanching rash. CT brain scan is normal, CSF shows 600 WBC (mostly neutrophils), glucose 1.1 mmol/l (blood glucose 7.6) protein 0.85 g/l, Gram stain is negative.

Cryptococcus neoformans
Neisseria meningitidis
Haemophilus influenzae type B
Echovirus
Mycobacterium tuberculosis

12. Another term for cerebral herniation

columing
craning
coning
cramming
cronation

13. acid alcohol-fast bacilli

Strep. pneumoniae
Neisseria meningitidis
Mycobacterium tuberculosis
Cryptococcus neoformans
Haemophilus influenzae

14. lanceolate Gram-positive diplococci

Haemophilus influenzae
Neisseria meningitidis
Mycobacterium tuberculosis
Cryptococcus neoformans
Strep. pneumoniae

15. What is an appropriate treatment for viral meningitis?

supportive only
Flucytosine
cefotaxime
Penicillin
Amphotericin B

16. Which of the following is NOT usually a clinical sign of meningitis?

Fever
Drowsiness
Confusion
Bradycardia
Nausea/vomiting

17. A gram-negative, oxidase-positive cause of meningits

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
Naeglaria fowleri
Cryptococcus neoformans

18. What is an appropriate treatment for bacterial meningitis?

Amphotericin B
supportive only
cefotaxime
Flucytosine
Candida albicans

19. Which of the following is a fungal cause of meningitis?

Cryptococcus neoformans
Naeglaria fowleri
Treponema pallidum
Salmonella enterica
Herpes simplex

20. 2-year-old boy, unwell for 2 days with increasing lethargy and crying. No childhood immunisations. CSF shows 1500 WBC (97% neutrophils), glucose 0.4 mmol/l (blood glucose 5.6), protein 0.9 g/l, and Gram stain shows Gram-negative coccobacilli.

Haemophilus influenzae type B
Mycobacterium tuberculosis
Neisseria meningitidis
Cryptococcus neoformans
Echovirus

21. A lumbar puncture is used to obtain a sample from the

epidural space
spinal cord
subarachnoid space
intervertebral space

22. pleomorphic Gram-negative cocco-bacilli

Haemophilus influenzae
Neisseria meningitidis
Mycobacterium tuberculosis
Cryptococcus neoformans
Strep. pneumoniae

23. A cause of meningitis: A slow growing bacterium (up to 8 weeks), acid alcohol-fast bacillus, does not stain with the Gram stain.

Cryptococcus neoformans
Neisseria meningitidis
Streptococcus pneumoniae
Mycobacterium tuberculosis
Haemophilus influenzae

24. A lumbar puncture is performed between the levels of

L4 & L5
L3 & L4
L2 & L3
L1 & L2
T12 & T1

25. Kernig's sign should be tested for if meningitis is suspected. How is it elicited?

Each shoulder is flexed in turn, and then attempt to straighten the elbow while keeping the shoulder flexed.
Each knee is flexed in turn, and then attempt to straighten the hip while keeping the knee flexed.
Attempt AP flexion/extension of the neck
Each hip is flexed in turn, and then attempt to straighten the knee while keeping the hip flexed.

26. Meningitis is an inflammation of the meninges surrounding the;

Periosteum
Subarachnoid space
Subdural space
Arachnoid villus
Saggital sinus

27. Which of the following is a viral cause of meningitis?

Cryptococcus neoformans
Herpes simplex
Naeglaria fowleri
Salmonella enterica
Treponema pallidum

28. Which of the following is most limited in meningitis?

AP flexion/extension
rotation
lateral flexion

29. Pathogenesis of meningitis; Blood-borne spread from local or bacteraemic infections, e.g.

pneumococcus
meningococcal
echovirus infection

30. Yeast cells surrounded by a clear halo in India ink preparations

Haemophilus influenzae
Neisseria meningitidis
Strep. pneumoniae
Cryptococcus neoformans
Mycobacterium tuberculosis

31. What is an appropriate treatment for fungal meningitis?

Amphotericin B + Flucytosine
Penicillin
supportive only
Amoxicillin
cefotaxime

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