[MCQ] Viral meningitis

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Viral meningitis

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Question 1

Which of the following viruses has a nonseasonal prevalence in causing viral meningitis ?

A	Arboviruses
B	LCMV
C	Mumps
D	HSV

Question 1 Explanation:

HSV & HIV viral meningitis have no seasonal predominance. Arboviruses & enteroviruses are frequent during summer/early fall. LCMV & mumps viruses cause viral meningitis during winter months.

Question 2

Which of the following is uncommon in viral meningitis ?

A	Fever
B	Headache
C	Meningeal irritation
D	Marked confusion

Question 3

Which of the following is common in viral meningitis ?

A	Kernig’s and Brudzinski’s signs
B	Headache - frontal or retroorbital
C	Focal neurological deficits
D	Seizures

Question 3 Explanation:

Headache in viral meningitis is usually frontal or retroorbital with photophobia, pain on moving eyes & mild teminal nuchal rigidity. Evidence of severe meningeal irritation, such as Kernig’s and Brudzinski’s signs, is generally absent. Seizures or other focal neurologic signs or symptoms suggest involvement of the brain parenchyma and do not occur in uncomplicated viral meningitis.

Question 4

Which of the following viruses is a less common cause of viral meningitis ?

A	Enteroviruses
B	Arboviruses
C	Adenoviruses
D	HSV-2

Question 4 Explanation:

Enteroviruses account for > 85 % of aseptic meningitis cases. Viruses belonging to the Enterovirus genus are members of the family Picornaviridae and include the coxsackieviruses, echoviruses, polioviruses, and human enteroviruses 68 to 71. Adenoviruses rarely cause viral meningitis.

Question 5

Typical CSF profile in viral meningitis includes all except ?

A	Lymphocytic pleocytosis - 25 to 500 cells/μL
B	Normal or slightly elevated protein - 20 to 80 mg/dL
C	Reduced glucose concentration
D	Normal or mildly elevated pressure (100 - 350 mm H2O)

Question 5 Explanation:

Examination of CSF is the most important laboratory test in the diagnosis of viral meningitis. The typical profile is a lymphocytic pleocytosis (25 to 500 cells/μL), a normal or slightly elevated protein concentration (20 to 80 mg/dL), a normal glucose concentration, and a normal or mildly elevated opening pressure (100 to 350 mm H2O).

Question 6

PMNs may predominate in CSF of viral meningitis in the first 48 hours of illness in which of the following infections ?

A	Echovirus 9
B	West Nile virus
C	Mumps
D	All of the above

Question 6 Explanation:

PMNs may predominate in the first 48 hours of illness, especially in patients with infections due to echovirus 9, West Nile virus or Eastern equine encephalitis virus, or mumps.

Question 7

Cell counts of several thousand per microliter are seen in viral meningitis due to which of the following ?

A	Echovirus 9
B	West Nile virus
C	Mumps
D	Arboviruses

Question 8

Cell counts of several thousand per microliter are seen in viral meningitis due to which of the following ?

A	Echovirus 9
B	West Nile virus
C	Lymphocytic choriomeningitis virus (LCMV)
D	Arboviruses

Question 8 Explanation:

Total CSF cell count in viral meningitis is typically 25 to 500/μL, although cell counts of several thousand per microliter are occasionally seen, especially with infections due to lymphocytic choriomeningitis virus (LCMV) and mumps virus.

Question 9

Low CSF glucose concentration is seen in viral meningitis due to which of the following ?

A	Echovirus 9
B	West Nile virus
C	Lymphocytic choriomeningitis virus (LCMV)
D	Arboviruses

Question 10

Low CSF glucose concentration is seen in viral meningitis due to which of the following ?

A	CMV
B	West Nile virus
C	Mumps
D	EBV

Question 10 Explanation:

The CSF glucose concentration is typically normal in viral infections, although it may be decreased in 10 to 30% of cases due to mumps as well as in cases due to LCMV.

Question 11

In CSF, lymphocytic pleocytosis with low glucose concentration should suggest which of the following ?

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

Question 12

In CSF, lymphocytic pleocytosis with low glucose concentration should suggest which of the following ?

A	Sarcoid
B	Neoplastic meningitis
C	Tuberculous meningitis
D	All of the above

Question 12 Explanation:

As a rule, a lymphocytic pleocytosis with a low glucose concentration should suggest fungal, listerial, or tuberculous meningitis or noninfectious disorders (e.g., sarcoid, neoplastic meningitis).

Question 13

Which of the following is the most important method for diagnosing CNS viral infections ?

A	Neopterin
B	β2-microglobulin
C	LDH
D	PCR amplification of viral nucleic acid

Question 13 Explanation:

Amplification of viral-specific DNA or RNA from CSF using PCR amplification is the single most important method for diagnosing CNS viral infections

Question 14

At what temperature should CSF be stored for culture for diagnosis of viral infection (> 24 hours) ?

A	- 20 ºC
B	- 40 ºC
C	- 50 ºC
D	70 ºC

Question 14 Explanation:

Beyond 24 hours, CSF specimens for viral isolation are stored in a (-)70°C freezer.

Question 15

Enteroviruses may be found in all except ?

A	Feces
B	Blood
C	Urine
D	Throat washings

Question 15 Explanation:

Enteroviruses & adenoviruses may be found in feces, arboviruses & LCMV in blood, mumps & CMV, in urine and enteroviruses, mumps, and adenoviruses in throat washings.

Question 16

Serologic studies are a crucial diagnostic tool for which of the following viruses ?

A	West Nile virus (WNV)
B	HSV
C	VZV
D	CMV

Question 16 Explanation:

For West Nile virus (WNV), serologic studies are a crucial diagnostic tool.

Question 17

Oligoclonal bands in CSF is not found in which of the following conditions ?

A	HIV infection
B	HSV infections
C	Subacute sclerosing panencephalitis (SSPE)
D	Progressive rubella panencephalitis

Question 17 Explanation:

Oligoclonal bands in CSF are not seen with arbovirus, enterovirus, or HSV infections. But, seen in infections with HIV, HTLV type I, VZV, mumps, SSPE & progressive rubella panencephalitis

Question 18

Oligoclonal bands are found in which of the following ?

A	Multiple sclerosis
B	Syphilis
C	Lyme borreliosis
D	All of the above

Question 18 Explanation:

Oligoclonal bands are encountered in multiple sclerosis, syphilis & Lyme borreliosis.

Question 19

‘Mollaret’s meningitis’ is due to ?

A	HIV
B	HSV
C	EBV
D	CMV

Question 19 Explanation:

‘Mollaret’s meningitis’ appear to be due to HSV.

Question 20

Aseptic meningitis occuring in winter, with a history of exposure to house mice excreta, leukopenia, thrombocytopenia and CSF pleocytosis suggest the diagnosis of which infection ?

A	HSV-2 infection
B	EBV infection
C	LCMV infection
D	Mumps

Question 20 Explanation:

LCMV infection should be considered when aseptic meningitis occurs in late fall or winter, and in individuals with a history of exposure to house mice (Mus musculus) excreta, rash, pulmonary infiltrates, alopecia, parotitis, orchitis, or myopericarditis. Laboratory clues to the diagnosis of LCMV include leukopenia, thrombocytopenia, abnormal LFT, marked CSF pleocytosis (>1000 cells/μL) and hypoglycorrachia (<30%).

Question 21

A case of viral meningitis with exanthemata, hand-foot-mouth disease, herpangina, pleurodynia, myopericarditis, and hemorrhagic conjunctivitis suggest the diagnosis of which infection ?

A	HSV-2 infection
B	EBV infection
C	LCMV infection
D	Enterovirus infection

Question 21 Explanation:

Enteroviruses are the most common cause of viral meningitis. Occur in summer months, especially in children. Physical findings may include exanthemata, hand-foot-mouth disease, herpangina, pleurodynia, myopericarditis, and hemorrhagic conjunctivitis.

Question 22

A case of viral meningitis occuring in clusters during summer should prompt for infection with ?

A	HSV-2 infection
B	Arbovirus infection
C	LCMV infection
D	Enterovirus infection

Question 22 Explanation:

Arbovirus infections typically occur in summer months, in both endemic & epidemic form, reflecting transmission through infected insect vectors. Arboviral meningitis should be considered when clusters of meningitis cases occur in a restricted geographic region during the summer or early fall.

Question 23

A case of viral meningitis complicated by acute cerebellar ataxia should prompt for infection with ?

A	HSV-2 infection
B	Arbovirus infection
C	LCMV infection
D	VZV CNS infection

Question 23 Explanation:

VZV meningitis should be suspected in the presence of concurrent chickenpox or shingles though up to 40% of VZV meningitis occur in the absence of rash. VZV can produce acute cerebellar ataxia.

Question 24

A case of viral meningitis along with orchitis, oophoritis, parotitis, pancreatitis should prompt for infection with ?

A	HSV-2 infection
B	Arbovirus infection
C	LCMV infection
D	Mumps infection

Question 24 Explanation:

Mumps meningitis occurs in late winter or early spring, especially in males. The presence of orchitis, oophoritis, parotitis, pancreatitis, or elevations in serum lipase and amylase are suggestive of the diagnosis. Clinical meningitis occurs in 5% of patients with parotitis, but only 50% of patients with meningitis have associated parotitis. Mumps infection confers lifelong immunity, so a documented history of previous infection excludes this diagnosis.

Question 25

Acyclovir therapy is of benefit in patients with meningitis caused by ?

A	HSV-1 or -2
B	Severe EBV infection
C	Severe VZV infection
D	All of the above

Question 25 Explanation:

Oral or intravenous acyclovir may be of benefit in patients with meningitis caused by HSV-1 or - 2 and in cases of severe EBV or VZV infection.

Question 26

“Pleconaril” is efficacious against which of the following infections ?

A	HSV-2 infection
B	EBV infection
C	LCMV infection
D	Enterovirus infection

Question 26 Explanation:

Pleconaril still an experimental drug has shown efficacy against a variety of enteroviral infections.

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See all quizzes of Viral meningitis here:

1 Which of the following viruses has a nonseasonal prevalence in
causing viral meningitis ?
A. Arboviruses
B. LCMV
C. Mumps
D. HSV

2 Which of the following is uncommon in viral meningitis ?
A. Fever
B. Headache
C. Meningeal irritation
D. Marked confusion

2 Which of the following is common in viral meningitis ?
A. Kernig’s and Brudzinski’s signs
B. Headache – frontal or retroorbital
C. Focal neurological deficits
D. Seizures

3 Which of the following viruses is a less common cause of viral
meningitis ?
A. Enteroviruses
B. Arboviruses
C. Adenoviruses
D. HSV-2

4 Typical CSF profile in viral meningitis includes all except ?
A. Lymphocytic pleocytosis – 25 to 500 cells/μL
B. Normal or slightly elevated protein – 20 to 80 mg/dL
C. Reduced glucose concentration
D. Normal or mildly elevated pressure (100 – 350 mm H2O)

5 PMNs may predominate in CSF of viral meningitis in the first 48
hours of illness in which of the following infections ?
A. Echovirus 9
B. West Nile virus
C. Mumps
D. All of the above

6 Cell counts of several thousand per microliter are seen in viral
meningitis due to which of the following ?
A. Echovirus 9
B. West Nile virus
C. Mumps
D. Arboviruses
7Cell counts of several thousand per microliter are seen in viral
meningitis due to which of the following ?
A. Echovirus 9
B. West Nile virus
C. Lymphocytic choriomeningitis virus (LCMV)
D. Arboviruses

8 Low CSF glucose concentration is seen in viral meningitis due to
which of the following ?
A. Echovirus 9
B. West Nile virus
C. Lymphocytic choriomeningitis virus (LCMV)
D. Arboviruses
9 Low CSF glucose concentration is seen in viral meningitis due to
which of the following ?
A. CMV
B. West Nile virus
C. Mumps
D. EBV

10 In CSF, lymphocytic pleocytosis with low glucose concentration
should suggest which of the following ?
A. Fungal meningitis
B. Listerial meningitis
C. Tuberculous meningitis
D. All of the above
11 In CSF, lymphocytic pleocytosis with low glucose concentration
should suggest which of the following ?
A. Sarcoid
B. Neoplastic meningitis
C. Tuberculous meningitis
D. All of the above

12 Which of the following is the most important method for
diagnosing CNS viral infections ?
A. Neopterin
B. 2-microglobulin
C. LDH
D. PCR amplification of viral nucleic acid

13 At what temperature should CSF be stored for culture for diagnosis
of viral infection (> 24 hours) ?
A. – 20 ºC
B. – 40 ºC
C. – 50 ºC
D. – 70 ºC

14 Enteroviruses may be found in all except ?
A. Feces
B. Blood
C. Urine
D. Throat washings

15 Serologic studies are a crucial diagnostic tool for which of the
following viruses ?
A. West Nile virus (WNV)
B. HSV
C. VZV
D. CMV

16 Oligoclonal bands in CSF is not found in which of the following
conditions ?
A. HIV infection
B. HSV infections
C. Subacute sclerosing panencephalitis (SSPE)
D. Progressive rubella panencephalitis

17 Oligoclonal bands are found in which of the following ?
A. Multiple sclerosis
B. Syphilis
C. Lyme borreliosis
D. All of the above

18 ‘Mollaret’s meningitis’ is due to ?
A. HIV
B. HSV
C. EBV
D. CMV

19Aseptic meningitis occuring in winter, with a history of exposure
to house mice excreta, leukopenia, thrombocytopenia and CSF
pleocytosis suggest the diagnosis of which infection ?
A. HSV-2 infection
B. EBV infection
C. LCMV infection
D. Mumps

20 A case of viral meningitis with exanthemata, hand-foot-mouth
disease, herpangina, pleurodynia, myopericarditis, and
hemorrhagic conjunctivitis suggest the diagnosis of which
infection ?
A. HSV-2 infection
B. EBV infection
C. LCMV infection
D. Enterovirus infection

21 A case of viral meningitis occuring in clusters during summer
should prompt for infection with ?
A. HSV-2 infection
B. Arbovirus infection
C. LCMV infection
D. Enterovirus infection

22 A case of viral meningitis complicated by acute cerebellar ataxia
should prompt for infection with ?
A. HSV-2 infection
B. Arbovirus infection
C. LCMV infection
D. VZV CNS infection

23 A case of viral meningitis along with orchitis, oophoritis, parotitis,
pancreatitis should prompt for infection with ?
A. HSV-2 infection
B. Arbovirus infection
C. LCMV infection
D. Mumps infection

24 Acyclovir therapy is of benefit in patients with meningitis caused
by ?
A. HSV-1 or -2
B. Severe EBV infection
C. Severe VZV infection
D. All of the above

25 “Pleconaril” is efficacious against which of the following infections ?
A. HSV-2 infection
B. EBV infection
C. LCMV infection
D. Enterovirus infection

Viral meningitis

[MCQ] Viral meningitis

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Viral meningitis

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