Infections of the Central Nervous System

Which statement describes the pathophysiology of Guillain-Barré syndrome? Destruction of axons by a direct bacterial infection An abnormal immune response to a preceding viral infection Impaired nerve conduction, primarily of afferent (sensory) nerves Early involvement of the axons of the proximal peripheral nerves, particularly the nerves of respiration

An abnormal immune response to a preceding viral infection

Which organs or tissues are involved in Reye's syndrome? (SATA) Brain Liver Kidneys Spinal cord Dermatomes

Brain Liver Kidneys

Which statements accurately describe Reye's syndrome? (SATA) Cause unknown Average mortality 30% Linked to a viral infection Occurs years after primary chickenpox Related to infection with Borrelia burgdorferi Occurs usually in children who have been treated with acetaminophen

Cause unknown Average mortality 30% Linked to a viral infection

Which is the cause of shingles? Infection with Neisseria meningitidis Previous infection with varicella zoster A previous mosquito bite or deer tick bite Infection with influenza followed by use of aspirin

Previous infection with varicella zoster

Which statements about disseminated intravascular coagulopathy (DIC) in CNS infections are correct? (SATA) DIC may be seen in viral encephalitis. DIC may be seen in bacterial meningitis. DIC contributes to bleeding into the adrenal glands. DIC causes the redness seen in varicella zoster rashes. If untreated, DIC leads to vascular collapse, shock, and death. DIC occurs as part of the multi-system organ failure in Reye's syndrome.

DIC may be seen in bacterial meningitis. DIC contributes to bleeding into the adrenal glands. If untreated, DIC leads to vascular collapse, shock, and death.

Which statements accurately describe the syndrome of rabies? (SATA) Death is likely. Symptom can include hydrophobia (a fear of drinking water). Liver and kidney failure are prominent complications. There is a characteristic rash in a dermatomal distribution. There is a rapid onset of symptoms after a bite by a rabid animal.

Death is likely. Symptom can include hydrophobia (a fear of drinking water).

How is Lyme disease transmitted? Deer tick bite Mosquito vector Respiratory droplets A bite by a rabid dog

Deer tick bite

Guillain-Barré syndrome has a unique pattern of progression of weakness. Arrange the parts of the body to describe the order in which the pattern manifests.

Feet and lower legs Thighs Lower back Muscles of respiration Muscles of the face

Which signs and symptoms are the most typical characteristic of acute bacterial meningitis? (SATA) Fever Photophobia Neck stiffness Weakness in the legs Rash in dermatomal distribution Bulging of the anterior fontanelle

Fever Photophobia Neck stiffness Bulging of the anterior fontanelle

How do bacteria reach the brain in meningitis? Select all that apply. From the blood stream By direct extension from nearby tissue By direct access from open head wounds As an ascending infection from a tick bite As an ascending infection from a rabid animal

From the blood stream By direct extension from nearby tissue By direct access from open head wounds

Which areas of the brain are commonly affected by brain abscesses? (SATA) Brain stem Cerebellum Frontal lobe Parietal lobe Occipital lobe Temporal lobe

Frontal lobe Temporal lobe

Which signs are likely to be seen in early Reye's syndrome? (SATA) Coma Liver failure Kidney failure Hyperventilation A rash on the hands and feet A rash in a dermatomal distribution

Hyperventilation A rash on the hands and feet

Which is the cause of Lyme disease? Infection by Borrelia burgdorferi A viral infection caused by a mosquito bite A delayed autoimmune response to the poliovirus An ascending neuropathic response after a bite by a rabid animal

Infection by Borrelia burgdorferi

Which are the clinical features of Guillain-Barré? (SATA) Painful rash Loss of reflexes Ascending flaccid paralysis Muscles of respiration involved Evolves over the course of hours or days Random muscle weakness over the course of years

Loss of reflexes Ascending flaccid paralysis Muscles of respiration involved Evolves over the course of hours or days

Which of these diseases is most likely to be present with nuchal rigidity? Meningitis Encephalitis Poliomyelitis Guillain-Barré syndrome

Meningitis

Match the common pathogens causing bacterial meningitis with the age group they are strongly associated with.

Neonates - Escherichia coli Older adults - Streptococcus pneumonia Young adults - Neisseria meningitides Young children - Haemophilus influenza

Which are correct descriptions of post-polio syndrome?(SATA) Acute onset after exposure to poliovirus Occurs in people who had polio as children Exact mechanism of nerve damage unknown Most likely a result of re-infection with polio Characterized by ascending weakness from the legs up

Occurs in people who had polio as children Exact mechanism of nerve damage unknown

When a person has shingles that involves the tip of the nose, he or she is at a high risk for visual impairment because of the involvement of which nerve? Optic nerve (Cranial Nerve II) Facial nerve (Cranial Nerve VII) Olfactory nerve (Cranial Nerve I) Ophthalmic branch of Cranial Nerve V

Ophthalmic branch of Cranial Nerve V

A child is diagnosed with Reye's syndrome. Which do you expect to find in the past medical history? Recent chickenpox Recent polio vaccine Recent exposure to Neisseria meningitidis Recent influenza-like syndrome treated with aspirin

Recent influenza-like syndrome treated with aspirin

Which statements apply to post-herpetic neuralgia? (SATA) Unusual in elderly patients Recurrent pain in the distribution of the rash Rash that appears in a dermatomal distribution May be present even after the rash disappears Seen in children shortly after disappearance of chickenpox

Recurrent pain in the distribution of the rash May be present even after the rash disappears

Rabies can affect tissues other than nervous tissue. Which glands can be affected by rabies? Thyroid gland Pituitary gland Adrenal glands Salivary glands

Salivary glands

Which signs and symptoms point more toward encephalitis than meningitis? (SATA) Seizures Stiff neck Confusion Drowsiness Bulging fontanelle

Seizures Confusion Drowsiness

Which organism is known to cause bacterial meningitis? Herpes zoster Clostridium tetani Borrelia burgdorferi Streptococcus pneumoniae

Streptococcus pneumoniae

Which statement is correct regarding post-polio syndrome? Only seen in children Begins weeks to months after a primary poliovirus infection Symptoms including muscle weakness and pain in the lower extremities Occuring in all patients who have had an initial infection with the poliovirus

Symptoms including muscle weakness and pain in the lower extremities

Which disease is caused by a spore-forming organism? Tetanus Meningitis Pneumonia Lyme disease

Tetanus

Which statements are true regarding the pathogenesis of tetanus?(SATA) The causative organism is Clostridium tetani. Tetanus results from the reactivation of chickenpox. The tetanus organism lives in soil, saliva, dust, and manure. A bite by a tetanus-carrying mosquito causes the syndrome. A break in the skin allows the exotoxin to enter the nervous system. Tetanus is a highly contagious disease spread through direct contact with oral droplets.

The causative organism is Clostridium tetani. The tetanus organism lives in soil, saliva, dust, and manure. A break in the skin allows the exotoxin to enter the nervous system.

Which statement accurately describes the cause of Guillain-Barré syndrome? The cause is unknown. Guillain-Barré syndrome is a delayed complication of the poliovirus. Guillain-Barré syndrome is seen in patients with a previous history of chickenpox. The cause has been confirmed to be related to giving aspirin to children with a viral infection.

The cause is unknown.

Which statement is the correct cause of Kernig's sign? Increased intracranial pressure Disseminated intravascular coagulopathy (DIC) Reactivation of a virus, leading to a dermatomal rash The meninges are inflamed, and stretching the meninges (like with a leg lift) causes intense pain

The meninges are inflamed, and stretching the meninges (like with a leg lift) causes intense pain

Rabies occurs after a bite from a rabid animal. What happens after the bite? The virus causes a rash in the distribution of a vertebral nerve. The virus travels through peripheral nerves to the central nervous system. Respiratory droplets cause an infection that leads to inflammation of the meninges. An autoimmune reaction causes weakness that starts in the legs and moves upward.

The virus travels through peripheral nerves to the central nervous system.

An individual develops a rash in a dermatomal distribution. Which statements are true? (SATA) This is most likely shingles or varicella zoster. The rash may result in persistent pain in the region. The rash will likely move to other areas on the same side of the body or face. The rash will not cross the midline because of the pattern of the dermatomes. The rash will likely spread to a symmetrical location on the other side of the midline.

This is most likely shingles or varicella zoster. The rash may result in persistent pain in the region. The rash will not cross the midline because of the pattern of the dermatomes.

Which is the most common cause of encephalitis? Fungi Viruses Head trauma Streptococcus pneumonia

Viruses