[MCQ] Viral Encephalitis- Part 1

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Viral Encephalitis- Part 1

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Question 1

Sporadic cases of encephalitis in immunocompetent adults are mostly caused by ?

A	HSV-1
B	West Nile virus (WNV)
C	St. Louis encephalitis virus
D	LaCrosse virus

Question 1 Explanation:

Most important viruses causing sporadic cases of encephalitis in immunocompetent adults are HSV-1, VZV and EBV. Epidemics of encephalitis are caused by arboviruses.

Question 2

Which of the following is a member of Flaviviruses ?

A	Eastern equine encephalitis virus
B	Western equine encephalitis virus
C	West Nile virus (WNV)
D	California encephalitis virus

Question 2 Explanation:

Epidemics of encephalitis are caused by arboviruses of which there are several groups like Alphaviruses (Eastern equine encephalitis virus, Western equine encephalitis virus), Flaviviruses (WNV, St. Louis encephalitis virus, Powassan virus), and Bunyaviruses (California encephalitis virus serogroup, LaCrosse virus).

Question 3

Viral “hemorrhagic” encephalitis can be seen in ?

A	HSV
B	Colorado tick fever virus
C	California encephalitis virus
D	All of the above

Question 3 Explanation:

~20% of patients with encephalitis have RBC’s (>500/μL) in CSF tap (hemorrhagic encephalitis) which is also seen with HSV, Colorado tick fever virus and California encephalitis virus.

Question 4

Which of the following seizure type occurs in a case of severe viral encephalitis ?

A	Absence (petit mal)
B	Tonic-clonic (grand mal)
C	Myoclonic
D	Any of the above

Question 4 Explanation:

Virtually every possible type of focal neurologic disturbance can occur in viral encephalitis.

Question 5

Which of the following focal neurolo

A	Aphasia
B	Ataxia
C	Hemiparesis
D	All of the above

Question 5 Explanation:

Most common focal findings in viral encephalitis are aphasia, ataxia, hemiparesis, involuntary movements & cranial nerve deficits

Question 6

“Atypical lymphocytes” in CSF of viral encephalitis are commonly seen in ?

A	EBV
B	CMV
C	HSV
D	Enteroviruses

Question 6 Explanation:

Atypical lymphocytes in CSF may be seen in EBV infection and less commonly with other viruses like CMV, HSV and enteroviruses

Question 7

CSF PCR is most sensitive for which of the following viruses causing viral encephalitis ?

A	WNV
B	HSV
C	Enterovirus
D	VZV

Question 7 Explanation:

Sensitivity is ~98% & specificity is ~94% of CSF HSV PCR.

Question 8

Presence in CSF of which class of antibody against WNV indicates WNV encephalitis ?

A	IgA
B	IgG
C	IgM
D	IgE

Question 8 Explanation:

Demonstration of WNV intrathecally synthesised IgM antibodies is diagnostic of WNV encephalitis. They do not cross blood-brain barrier

Question 9

Which of the following about HSV-1 encephalitis is false ?

A	Focal findings in MRI
B	Invariably negative CSF cultures
C	Most sensitive CSF HSV PCR
D	None of the above

Question 9 Explanation:

Focal findings in encephalitis raises the possibility of HSV encephalitis. Cultures are invariably negative in cases of HSV-1 encephalitis. CSF HSV PCR has a sensitivity of ~98%.

Question 10

In MRI, which cortical lobe of brain is most affected in HSV encephalitis ?

A	Frontal
B	Temporal
C	Parietal
D	Occipital

Question 11

In MRI of viral encephalitis, abnormalities involving deep brain structures like thalamus, basal ganglia, and brainstem rather than cortex indicate infection with which of the following viruses ?

A	HSV
B	VZV
C	WNV
D	All of the above

Question 11 Explanation:

MRI abnormalities of patients with WNV encephalitis involve deep brain structures like thalamus, basal ganglia & brainstem rather than cortex. Presentation is therefore with prominent movement disorders (tremor, myoclonus) or Parkinsonism. Patients with WNV infection can also present with acute poliomyelitis-like areflexic paralysis.

Question 12

In MRI of viral encephalitis, areas of hemorrhagic infarction reflect infection with which of the following viruses ?

A	HSV
B	VZV
C	WNV
D	All of the above

Question 12 Explanation:

Patients with VZV encephalitis show areas of hemorrhagic infarction pointing towards a CNS vasculopathy rather than a true encephalitis

Question 13

Which of the following bacterial infection most commonly mimic viral encephalitis ?

A	Listeria
B	Bartonella
C	Mycoplasma
D	Leptospira

Question 13 Explanation:

Bartonella infection is the most common bacterial infection mimicking viral encephalitis.

Question 14

In viral encephalitis, infection with which of the following can present as acute ascending paralysis resembling Guillain-Barre’ syndrome ?

A	HIV infection
B	Rabies
C	WNV
D	All of the above

Question 14 Explanation:

Acute ascending paralysis resembling Guillain-Barre’ syndrome but associated with CSF pleocytosis can occur with HIV infection, rabies, and WNV infection.

Question 15

Abnormalities in MRI are found in which of the following regions of the brain in viral encephalitis caused by rabies ?

A	Brainstem
B	Hippocampus
C	Hypothalamus
D	All of the above

Question 15 Explanation:

In rabies, CSF lymphocytic pleocytosis with areas of increased T2 signal abnormality in brainstem, hippocampus & hypothalamus are seen.

Question 16

PCR amplification of viral nucleic acid for diagnosis of viral encephalitis caused by rabies can be done from ?

A	CSF
B	Saliva
C	Tears
D	All of the above

Question 16 Explanation:

PCR amplification of viral nucleic acid from CSF and saliva or tears may also enable diagnosis.

Question 17

Enzyme in HSV, VZV, and EBV that phosphorylates acyclovir to produce acyclovir-5` monophosphate is ?

A	2`deoxyguanosine
B	3`deoxyguanosine
C	Deoxypyrimidine kinase
D	Pyrimidine kinase

Question 17 Explanation:

HSV, VZV, & EBV encode enzyme, deoxypyrimidine (thymidine) kinase, that phosphorylates acyclovir to produce acyclovir-5`-monophosphate

Question 18

Which of the following metabolite of acyclovir acts as an antiviral agent by inhibiting viral DNA polymerase ?

A	Monophosphate
B	Biphosphate
C	Triphosphate
D	Any of the above

Question 18 Explanation:

Infected host cell enzymes phosphorylate acyclovir-5`-monophosphate to form a triphosphate derivative which acts as an antiviral agent by inhibiting viral DNA polymerase & by causing premature termination of nascent viral DNA chains.

Question 19

In adults suffering from HSV encephalitis, duration of intravenous acyclovir therapy should be for a minimum period of ?

A	3 days
B	7 days
C	10 days
D	14 days

Question 20

In neonates suffering from HSV encephalitis, duration of intravenous acyclovir therapy should be for a minimum period of ?

A	5 days
B	10 days
C	14 days
D	21 days

Question 20 Explanation:

Adults should receive a dose of 10 mg/kg of acyclovir IV 8 hourly (30 mg/kg/day) for at least 14 days. Neonates with HSV encephalitis receive 20 mg/kg of acyclovir 8 hourly (60 mg/kg/day) for at least 21 days.

Question 21

Which of the following is not a side effect of IV acyclovir ?

A	Hemolysis
B	Elevations in BUN & creatinine
C	Thrombocytopenia
D	Neurotoxicity

Question 21 Explanation:

Complications of acyclovir therapy are elevations in BUN & creatinine levels (5%), thrombocytopenia (6%), GI toxicity (7%) & neurotoxicity (lethargy, obtundation, disorientation, confusion, agitation, hallucinations, tremors, seizures) (1%). Hemolysis, with resulting anemia, is a major side effect of IV ribavarin therapy

Question 22

Which of the following drug is effective in CMV-related CNS infections ?

A	Ganciclovir
B	Foscarnet
C	Cidofovir
D	All of the above

Question 22 Explanation:

Ganciclovir & foscarnet (often used in combination) are effective in CMV-related CNS infections. Cidofovir may provide an alternative in patients who fail to respond to ganciclovir and foscarnet

Question 23

Which of the following drugs is useful for treatment of WNV encephalitis ?

A	Ganciclovir
B	Foscarnet
C	Cidofovir
D	None of the above

Question 24

Incidence & severity of sequelae in patients surviving viral encephalitis is more in infections with ?

A	Eastern equine encephalitis virus
B	EBV
C	California encephalitis virus
D	Venezuelan equine encephalitis virus

Question 24 Explanation:

In Eastern equine encephalitis virus infection, ~80% of survivors have severe neurologic sequelae. Severe sequelae are unusual in EBV, California & Venezuelan equine encephalitis

Question 25

Incidence & severity of sequelae of viral encephalitis depends on which of the following ?

A	Age of patient
B	Level of consciousness at time of initiation of therapy
C	Amount of HSV DNA in CSF at time of presentation
D	All of the above

Question 25 Explanation:

Incidence & severity of sequelae are directly related to age of patient & level of consciousness at initiation of therapy. Clinical outcome following treatment correlates with amount of HSV DNA in CSF at presentation.

Question 26

Most common pathogen causing fungal meningitis is ?

A	Coccidioides immitis
B	Histoplasma capsulatum
C	Cryptococcus neoformans
D	Candida

Question 26 Explanation:

The most common pathogen causing fungal meningitis is C. neoformans.

Question 27

Which of the following cranial nerve is most frequently involved in T. pallidum invasion of CNS ?

A	II
B	III
C	VII
D	XII

Question 27 Explanation:

Cranial nerves VII and VIII are most frequently involved in syphilis.

Question 28

Negative result of which of the following does not rule out neurosyphilis ?

A	CSF VDRL
B	CSF FTA-ABS
C	MHA-TP
D	All of the above

Question 28 Explanation:

A negative CSF VDRL does not rule out neurosyphilis. A negative CSF FTA-ABS or MHA-TP rules out neurosyphilis.

Question 29

In tuberculous meningitis, which sample of CSF is best for detecting acid-fast bacilli (AFB) ?

A	First tube
B	Middle tube
C	Last tube
D	Any of the above

Question 29 Explanation:

In TBM, last tube of CSF collected at LP is the best tube to send for a smear for AFB. If there is a pellicle in CSF or a cobweb-like clot on surface of fluid, AFB is demonstrated in smear of clot / pellicle.

Question 30

In progressive multifocal leukoencephalopathy, which of the following is not involved ?

A	Frontal cortex
B	Cerebellum
C	Midbrain
D	Spinal cord

Question 30 Explanation:

In PML, multifocal areas of demyelination distributed throughout the brain but sparing spinal cord and optic nerves are seen.

Question 31

Which of the following is false about progressive multifocal leukoencephalopathy ?

A	Occurs in immunosuppressed population
B	Only known manifestation of JC virus infection
C	Late manifestation of AIDS
D	None of the above

Question 32

Which of the following is useful for the diagnosis of progressive multifocal leukoencephalopathy ?

A	EEG
B	CT scan of brain
C	Positive CSF PCR for JCV DNA
D	Serologic studies for JC virus

Question 32 Explanation:

Positive CSF PCR for JCV DNA with typical MRI lesions in appropriate clinical setting is diagnostic of PML.

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See all quizzes of Viral Encephalitis here:

1 Sporadic cases of encephalitis in immunocompetent adults are
mostly caused by ?
A. HSV-1
B. West Nile virus (WNV)
C. St. Louis encephalitis virus
D. LaCrosse virus

2 Which of the following is a member of Flaviviruses ?
A. Eastern equine encephalitis virus
B. Western equine encephalitis virus
C. West Nile virus (WNV)
D. California encephalitis virus

3 Viral “hemorrhagic” encephalitis can be seen in ?
A. HSV
B. Colorado tick fever virus
C. California encephalitis virus
D. All of the above

4 Which of the following seizure type occurs in a case of severe
viral encephalitis ?
A. Absence (petit mal)
B. Tonic-clonic (grand mal)
C. Myoclonic
D. Any of the above

5 Which of the following focal neurological findings is commonly
encountered in viral encephalitis ?
A. Aphasia
B. Ataxia
C. Hemiparesis
D. All of the above

6 “Atypical lymphocytes” in CSF of viral encephalitis are commonly
seen in ?
A. EBV
B. CMV
C. HSV
D. Enteroviruses

7 CSF PCR is most sensitive for which of the following viruses
causing viral encephalitis ?
A. WNV
B. HSV
C. Enterovirus
D. VZV

8 Presence in CSF of which class of antibody against WNV indicates
WNV encephalitis ?
A. IgA
B. IgG
C. IgM
D. IgE
Demonstration of WNV intrathecally synthesised IgM antibodies is diagnostic of WNV encephalitis.
They do not cross blood-brain barrier.
9 Which of the following about HSV-1 encephalitis is false ?
A. Focal findings in MRI
B. Invariably negative CSF cultures
C. Most sensitive CSF HSV PCR
D. None of the above

10 In MRI, which cortical lobe of brain is most affected in HSV
encephalitis ?
A. Frontal
B. Temporal
C. Parietal
D. Occipital

11 In MRI of viral encephalitis, abnormalities involving deep brain
structures like thalamus, basal ganglia, and brainstem rather than
cortex indicate infection with which of the following viruses ?
A. HSV
B. VZV
C. WNV
D. All of the above

12 In MRI of viral encephalitis, areas of hemorrhagic infarction reflect
infection with which of the following viruses ?
A. HSV
B. VZV
C. WNV
D. All of the above

13 Which of the following bacterial infection most commonly mimic
viral encephalitis ?
A. Listeria
B. Bartonella
C. Mycoplasma
D. Leptospira

14 In viral encephalitis, infection with which of the following can
present as acute ascending paralysis resembling Guillain-Barre’
syndrome ?
A. HIV infection
B. Rabies
C. WNV
D. All of the above

15 Abnormalities in MRI are found in which of the following regions
of the brain in viral encephalitis caused by rabies ?
A. Brainstem
B. Hippocampus
C. Hypothalamus
D. All of the above

16 PCR amplification of viral nucleic acid for diagnosis of viral
encephalitis caused by rabies can be done from ?
A. CSF
B. Saliva
C. Tears
D. All of the above

17 Enzyme in HSV, VZV, and EBV that phosphorylates acyclovir to
produce acyclovir-5` monophosphate is ?
A. 2`deoxyguanosine
B. 3`deoxyguanosine
C. Deoxypyrimidine kinase
D. Pyrimidine kinase

18 Which of the following metabolite of acyclovir acts as an antiviral
agent by inhibiting viral DNA polymerase ?
A. Monophosphate
B. Biphosphate
C. Triphosphate
D. Any of the above

19 In adults suffering from HSV encephalitis, duration of intravenous
acyclovir therapy should be for a minimum period of ?
A. 3 days
B. 7 days
C. 10 days
D. 14 days
20 In neonates suffering from HSV encephalitis, duration of
intravenous acyclovir therapy should be for a minimum period of
?
A. 5 days
B. 10 days
C. 14 days
D. 21 days

21 Which of the following is not a side effect of IV acyclovir ?
A. Hemolysis
B. Elevations in BUN & creatinine
C. Thrombocytopenia
D. Neurotoxicity

22 Which of the following drug is effective in CMV-related CNS
infections ?
A. Ganciclovir
B. Foscarnet
C. Cidofovir
D. All of the above

23 Which of the following drugs is useful for treatment of WNV
encephalitis ?
A. Ganciclovir
B. Foscarnet
C. Cidofovir
D. None of the above
24 Incidence & severity of sequelae in patients surviving viral
encephalitis is more in infections with ?
A. Eastern equine encephalitis virus
B. EBV
C. California encephalitis virus
D. Venezuelan equine encephalitis virus

25 Incidence & severity of sequelae of viral encephalitis depends on
which of the following ?
A. Age of patient
B. Level of consciousness at time of initiation of therapy
C. Amount of HSV DNA in CSF at time of presentation
D. All of the above

26 Most common pathogen causing fungal meningitis is ?
A. Coccidioides immitis
B. Histoplasma capsulatum
C. Cryptococcus neoformans
D. Candida

27 Which of the following cranial nerve is most frequently involved
in T. pallidum invasion of CNS ?
A. II
B. III
C. VII
D. XII

28 Negative result of which of the following does not rule out
neurosyphilis ?
A. CSF VDRL
B. CSF FTA-ABS
C. MHA-TP
D. All of the above

29 In tuberculous meningitis, which sample of CSF is best for
detecting acid-fast bacilli (AFB) ?
A. First tube
B. Middle tube
C. Last tube
D. Any of the above

30 In progressive multifocal leukoencephalopathy, which of the
following is not involved ?
A. Frontal cortex
B. Cerebellum
C. Midbrain
D. Spinal cord

31 Which of the following is false about progressive multifocal
leukoencephalopathy ?
A. Occurs in immunosuppressed population
B. Only known manifestation of JC virus infection
C. Late manifestation of AIDS
D. None of the above
32 Which of the following is useful for the diagnosis of progressive
multifocal leukoencephalopathy ?
A. EEG
B. CT scan of brain
C. Positive CSF PCR for JCV DNA
D. Serologic studies for JC virus

Viral Encephalitis

[MCQ] Viral Encephalitis- Part 1

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Viral Encephalitis- Part 1

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