[MCQ] Meningitis, Encephalitis, Brain Abscess, and Empyema

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Meningitis, Encephalitis, Brain Abscess, and Empyema

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Question 1

Cerebritis is best related to ?

A	Encephalitis
B	Meningitis
C	Abscess
D	Thrombophlebitis

Question 1 Explanation:

Focal bacterial, fungal or parasitic infections involving brain tissue are classified as either cerebritis or abscess, depending on the presence or absence of a capsule. When brain tissue is directly injured by a viral infection the disease is referred to as encephalitis.

Question 2

While eliciting Brudzinski’s sign which part of body is passively moves ?

A	Hip joint
B	Knee joint
C	Neck
D	Ankle joint

Question 2 Explanation:

Brudzinski’s sign is positive when passive flexion of neck results in spontaneous flexion of hips & knees.

Question 3

In adults, organism most commonly responsible for communityacquired bacterial meningitis is ?

A	N. meningitidis
B	Streptococcus pneumoniae
C	Group B streptococci
D	H. influenzae

Question 3 Explanation:

Organisms responsible for community-acquired bacterial meningitis are S. pneumoniae (~50%), N. meningitidis (~25%), group B streptococci (~15%), Listeria monocytogenes (~10%) & H. influenzae (<10%).

Question 4

Individuals with deficiencies of which of the following are highly susceptible to meningococcal infections ?

A	Galectin-1
B	Properdin
C	Pentraxin
D	Cathelin

Question 4 Explanation:

Individuals with deficiencies of any of the complement components, including properdin, are highly susceptible to meningococcal infections.

Question 5

Which of the following is present in relatively small amounts in normal CSF ?

A	White blood cells (WBCs)
B	Complement proteins
C	Immunoglobulins
D	All of the above

Question 5 Explanation:

Normal CSF contains few white blood cells (WBCs) and relatively small amounts of complement proteins and immunoglobulins.

Question 6

Raised intracranial pressure in bacterial meningitis is due to ?

A	Interstitial edema
B	Vasogenic edema
C	Cytotoxic edema
D	All of the above

Question 6 Explanation:

The combination of interstitial, vasogenic, and cytotoxic edema leads to raised ICP and coma.

Question 7

Which of the following is not a feature of classic clinical triad of meningitis ?

A	Fever
B	Headache
C	Vomiting
D	Nuchal rigidity

Question 7 Explanation:

The classic clinical triad of meningitis is fever, headache & nuchal rigidity. Decreased level of consciousness occurs in >75% of patients. Nausea, vomiting & photophobia are also common complaints

Question 8

Generalized seizure and status epilepticus in bacterial meningitis may be due to ?

A	Hyponatremia
B	Cerebral anoxia
C	Toxic effects of antimicrobial agents
D	All of the above

Question 8 Explanation:

Generalized seizure activity & status epilepticus in bacterial meningitis may be due to hyponatremia, cerebral anoxia or less commonly, toxic effects of antimicrobial agents (high-dose penicillin).

Question 9

Over 90% of patients of bacterial meningitis have a CSF opening pressure of ?

A	> 100 mm H2O
B	> 120 mm H2O
C	> 160 mm H2O
D	> 180 mm H2O

Question 9 Explanation:

More than 90% of patients will have a CSF opening pressure >180 mmH2O.

Question 10

Cushing reflex in raised ICP relates to ?

A	Bradycardia
B	Hypertension
C	Irregular respirations
D	All of the above

Question 10 Explanation:

Cushing reflex includes bradycardia, hypertension & irregular respirations.

Question 11

In bacterial meningitis, CSF / serum glucose ratio is ?

A	< 0.4
B	< 0.5
C	< 0.6
D	< 0.8

Question 11 Explanation:

CSF/serum glucose ratio in bacterial meningitis is <0.4 in ~60% of patients.

Question 12

CSF glucose concentration is low when CSF/serum glucose ratio is ?

A	< 0.4
B	< 0.5
C	< 0.6
D	< 0.8

Question 12 Explanation:

CSF glucose concentration is low when CSF/serum glucose ratio is <0.6.

Question 13

CSF / serum glucose ratio of <0.4 is seen in ?

A	Fungal meningitis
B	Tuberculous meningitis
C	Carcinomatous meningitis
D	All of the above

Question 13 Explanation:

Besides bacterial meningitis, CSF/serum glucose ratio <0.4 is also seen in fungal, tuberculous, and carcinomatous meningitis.

Question 14

Limulus amebocyte lysate assay in CSF is diagnostic of ?

A	Gram-negative bacterial meningitis
B	Fungal meningitis
C	Tuberculous meningitis
D	Carcinomatous meningitis

Question 14 Explanation:

Limulus amebocyte lysate assay detects gram-negative endotoxin in CSF & is diagnostic of gramnegative bacterial meningitis.

Question 15

In Rocky Mountain spotted fever (RMSF), skin rash typically begins in ?

A	Face and scalp
B	Wrists and ankles
C	Chest and abdomen
D	Neck

Question 15 Explanation:

Skin rash in RMSF typically begins in wrist & ankles. It spreads distally & proximally rapidly to involve palms & soles.

Question 16

Vogt-Koyanagi-Harada syndrome refers to ?

A	Drug-induced hypersensitivity meningitis
B	Carcinomatous meningitis
C	Meningitis associated with sarcoid
D	Uveomeningitic syndromes

Question 16 Explanation:

Vogt-Koyanagi-Harada syndrome refers to uveomeningitic syndromes.

Question 17

Which of the following causes a subacutely evolving meningitis ?

A	Mycobacterium tuberculosis
B	Cryptococcus neoformans
C	Treponema pallidum
D	All of the above

Question 17 Explanation:

Subacutely evolving meningitis is caused by Mycobacterium tuberculosis, Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis and Treponema pallidum.

Question 18

In bacterial meningitis, the goal is to begin antibiotic therapy within what time of patient’s arrival ?

A	1 hour
B	3 hour
C	6 hour
D	12 hour

Question 18 Explanation:

In bacterial meningitis, the goal is to begin antibiotic therapy within 60 minutes of patient’s arrival in the emergency room.

Question 19

Which of the following cephalosporin is preferred in CNS infection with P. aeruginosa ?

A	Ceftriaxone
B	Cefotaxime
C	Ceftazidime
D	None of the above

Question 19 Explanation:

Meningitis due to P. aeruginosa should be treated with ceftazidime, cefepime, or meropenem

Question 20

Close contacts of a patient of meningococcal meningitis should receive chemoprophylaxis with ?

A	Rifampin
B	Ciprofloxacin
C	Azithromycin
D	Any of the above

Question 20 Explanation:

Close contacts of meningococcal meningitis patient should receive chemoprophylaxis with rifampin, ciprofloxacin, azithromycin or ceftriaxone.

Question 21

In meningococcal meningitis chemoprophylaxis, adult dose of rifampin is ?

A	450 mg once a day for 1 days
B	450 mg twice a day for 2 days
C	600 mg once a day for 1 days
D	600 mg twice a day for 2 days

Question 21 Explanation:

In meningococcal meningitis chemoprophylaxis, rifampin is given as a 2-day regimen of 600 mg every 12 hour for 2 days in adults.

Question 22

Which antibiotic should be added to the empirical regimen in acute meningitis for coverage of L. monocytogenes ?

A	Ampicillin
B	Nafcillin
C	Penicillin G
D	Metronidazole

Question 22 Explanation:

Ampicillin should be added to the empirical regimen for coverage of L. monocytogenes.

Question 23

Which of the following is false about vancomycin therapy in S. pneumoniae meningitis ?

A	Antibiotic of choice if cephalosporin MIC is >1 μg/mL
B	Rifampin produces synergistic effect to vancomycin
C	Vancomycin can be given by intraventricular route
D	None of the above

Question 24

When should dexamethasone be given in acute bacterial meningitis ?

A	Before antibiotic therapy
B	Along with antibiotic therapy
C	After antibiotic therapy
D	Any of the above

Question 24 Explanation:

Rationale for giving dexamethasone 20 minutes before antibiotic therapy is that it inhibits production of TNF by macrophages & microglia only if it is administered before these cells are activated by endotoxin.

Question 25

Benefit of dexamethasone therapy is not significant if started how many hours after antimicrobial therapy ?

A	> 1 hour
B	> 3 hours
C	> 6 hours
D	> 12 hours

Question 25 Explanation:

Dexamethasone therapy is unlikely to be of significant benefit if started > 6 hours after antimicrobial therapy has been initiated.

Question 26

Benefits of dexamethasone therapy are most striking in patients with ?

A	Gram-negative bacterial meningitis
B	Pneumococcal meningitis
C	Meningococcal meningitis
D	Staphylococcal meningitis

Question 27

Mortality is higher in meningitis due to ?

A	H. influenzae
B	N. meningitidis
C	L. monocytogenes
D	S. pneumoniae

Question 27 Explanation:

Mortality is 3 - 7% for meningitis caused by H. influenzae, N. meningitidis or group B streptococci. 15% for that due to L. monocytogenes and 20% for S. pneumoniae.

Question 28

Predictors of increased mortality in bacterial meningitis include ?

A	Onset of seizures within 24 hours of admission
B	CSF glucose concentration of < 40 mg/dL
C	CSF protein concentration of > 300 mg/dL
D	All of the above

Question 28 Explanation:

Risk of death from bacterial meningitis increases with decreased level of consciousness on admission, onset of seizures within 24 hours of admission, signs of increased ICP, young age (infancy) & age >50, presence of shock and/or need for mechanical ventilation, delay in initiation of treatment, CSF glucose concentration <40 mg/dL and CSF protein >300 mg/dL.

Question 29

Common sequelae of bacterial meningitis include all except ?

A	Decreased intellectual function
B	Seizures
C	Visual loss
D	Hearing loss

Question 29 Explanation:

Common sequelae of bacterial meningitis include decreased intellectual function, memory impairment, seizures, hearing loss & dizziness & gait disturbances

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See all quizzes of Meningitis, Encephalitis, Brain Abscess, and Empyema System here:

1 Cerebritis is best related to ?
A. Encephalitis
B. Meningitis
C. Abscess
D. Thrombophlebitis

2 While eliciting Brudzinski’s sign which part of body is passively
moves ?
A. Hip joint
B. Knee joint
C. Neck
D. Ankle joint

3 In adults, organism most commonly responsible for communityacquired
bacterial meningitis is ?
A. N. meningitidis
B. Streptococcus pneumoniae
C. Group B streptococci
D. H. influenzae

3 Individuals with deficiencies of which of the following are highly
susceptible to meningococcal infections ?
Harrison’s 18th Ed. 3411
A. Galectin-1
B. Properdin
C. Pentraxin
D. Cathelin

4 Which of the following is present in relatively small amounts in
normal CSF ?
A. White blood cells (WBCs)
B. Complement proteins
C. Immunoglobulins
D. All of the above

5 Raised intracranial pressure in bacterial meningitis is due to ?
A. Interstitial edema
B. Vasogenic edema
C. Cytotoxic edema
D. All of the above

6 Which of the following is not a feature of classic clinical triad of
meningitis ?
A. Fever
B. Headache
C. Vomiting
D. Nuchal rigidity

7 Generalized seizure and status epilepticus in bacterial meningitis
may be due to ?
A. Hyponatremia
B. Cerebral anoxia
C. Toxic effects of antimicrobial agents
D. All of the above

8 Over 90% of patients of bacterial meningitis have a CSF opening
pressure of ?
A. > 100 mm H2O
B. > 120 mm H2O
C. > 160 mm H2O
D. > 180 mm H2O

9 Cushing reflex in raised ICP relates to ?
A. Bradycardia
B. Hypertension
C. Irregular respirations
D. All of the above

10 In bacterial meningitis, CSF / serum glucose ratio is ?
A. < 0.4
B. < 0.5
C. < 0.6
D. < 0.8

11 CSF glucose concentration is low when CSF/serum glucose ratio
is ?
A. < 0.4
B. < 0.5
C. < 0.6
D. < 0.8

12 CSF / serum glucose ratio of <0.4 is seen in ?
A. Fungal meningitis
B. Tuberculous meningitis
C. Carcinomatous meningitis
D. All of the above

13 Limulus amebocyte lysate assay in CSF is diagnostic of ?
A. Gram-negative bacterial meningitis
B. Fungal meningitis
C. Tuberculous meningitis
D. Carcinomatous meningitis

14 In Rocky Mountain spotted fever (RMSF), skin rash typically begins
in ?
A. Face and scalp
B. Wrists and ankles
C. Chest and abdomen
D. Neck

15 Vogt-Koyanagi-Harada syndrome refers to ?
A. Drug-induced hypersensitivity meningitis
B. Carcinomatous meningitis
C. Meningitis associated with sarcoid
D. Uveomeningitic syndromes

16 Which of the following causes a subacutely evolving meningitis ?
A. Mycobacterium tuberculosis
B. Cryptococcus neoformans
C. Treponema pallidum
D. All of the above

17 In bacterial meningitis, the goal is to begin antibiotic therapy
within what time of patient’s arrival ?
A. 1 hour
B. 3 hour
C. 6 hour
D. 12 hour

18 Which of the following cephalosporin is preferred in CNS infection
with P. aeruginosa ?
A. Ceftriaxone
B. Cefotaxime
C. Ceftazidime
D. None of the above

19 Close contacts of a patient of meningococcal meningitis should
receive chemoprophylaxis with ?
A. Rifampin
B. Ciprofloxacin
C. Azithromycin
D. Any of the above

20 In meningococcal meningitis chemoprophylaxis, adult dose of
rifampin is ?
A. 450 mg once a day for 1 days
B. 450 mg twice a day for 2 days
C. 600 mg once a day for 1 days
D. 600 mg twice a day for 2 days

21 Which antibiotic should be added to the empirical regimen in
acute meningitis for coverage of L. monocytogenes ?
A. Ampicillin
B. Nafcillin
C. Penicillin G
D. Metronidazole

22 Which of the following is false about vancomycin therapy in S.
pneumoniae meningitis ?
A. Antibiotic of choice if cephalosporin MIC is >1 μg/mL
B. Rifampin produces synergistic effect to vancomycin
C. Vancomycin can be given by intraventricular route
D. None of the above
23 When should dexamethasone be given in acute bacterial meningitis ?
A. Before antibiotic therapy
B. Along with antibiotic therapy
C. After antibiotic therapy
D. Any of the above

24 Benefit of dexamethasone therapy is not significant if started how
many hours after antimicrobial therapy ?
A. > 1 hour
B. > 3 hours
C. > 6 hours
D. > 12 hours

25 Benefits of dexamethasone therapy are most striking in patients
with ?
A. Gram-negative bacterial meningitis
B. Pneumococcal meningitis
C. Meningococcal meningitis
D. Staphylococcal meningitis
26 Mortality is higher in meningitis due to ?
A. H. influenzae
B. N. meningitidis
C. L. monocytogenes
D. S. pneumoniae

27 Predictors of increased mortality in bacterial meningitis include ?
A. Onset of seizures within 24 hours of admission
B. CSF glucose concentration of < 40 mg/dL
C. CSF protein concentration of > 300 mg/dL
D. All of the above

28 Common sequelae of bacterial meningitis include all except ?
A. Decreased intellectual function
B. Seizures
C. Visual loss
D. Hearing loss

[MCQ] Meningitis, Encephalitis, Brain Abscess, and Empyema

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Meningitis, Encephalitis, Brain Abscess, and Empyema

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