MKSAP 18: Infectious Disease - CNS
Infections UPDATED ACTUAL Exam
Questions and CORRECT Answers
Most common cause of viral meningitis in May through November - CORRECT
ANSWER - enteroviruses
This virus can cause viral meningitis year round (think, outside of May to November) -
CORRECT ANSWER - HSV-1 and HSV-2 but HSV-2 more common
Leads to a flaccid paralysis with meningitis. Can cause death. Mosquito vector (hence, summer
months) - CORRECT ANSWER - West Nile Virus
Fever, rash, and mononucleosis-like syndrome with a viral meningitis - CORRECT
ANSWER - HIV
Lab test to confirm suspected West Nile Virus - CORRECT ANSWER - CSF IgM
Viral meningitis symptoms - CORRECT ANSWER - headache, fever, nuchal rigidity,
photophobia, nausea, vomiting, myalgias, pharyngitis, maculopapular rash, and cough
Role of gram staining in meningitis assessment - CORRECT ANSWER - Great if it comes
back positive (although this is in less than 5% of cases): leads you immediately to a gram +,
bacterial meningitis. Otherwise further workup of CSF (glucose, protein and pressure analysis)
and possible PCR is needed.
In what cases is an increased CSF opening pressure predicted - CORRECT ANSWER -
Bacterial and fungal (also +/- in viral)
In what cases is an increased protein in CSF expected? - CORRECT ANSWER - All 3
types of meningitis (possibly normal in viral)
, In what cases is gram stain positive in CSF? - CORRECT ANSWER - Gram positive
bacterial infection (but only 60-90% of even the gram + infections, not counting the gram
negatives)
In what cases are the CSF glucose expected to be low? - CORRECT ANSWER - Bacterial
meningitis and fungal (it eats the glucose)... also the same instances when increased CSF
opening pressure could be noted)
What types of meningitis show a pleocytosis of lymphocytes? - CORRECT ANSWER -
Viral and fungal
What types of meningitis show a pleocytosis of PMNs? - CORRECT ANSWER - bacterial
Why do you sometimes see a predominance of PMNs / leukocytes in VIRAL meningitis? -
CORRECT ANSWER - Early in infections PMNs are higher, dont be mislead on this
because lymphocytes can predominate later...
Three mosquito borne viral meningitis types - CORRECT ANSWER - St. Louis,
California, West Nile
Common signs of bacterial meningitis - CORRECT ANSWER - Acute meningeal signs:
fever, nuchal rigidity and AMS
Most common type of bacterial meningitis - CORRECT ANSWER - streptococcus
pneumoniae
Two previously common causes of bacterial meningitis, before conjugate vaccines - CORRECT
ANSWER - Haemophilus Influenzae and Neisseria meningitis
Infections UPDATED ACTUAL Exam
Questions and CORRECT Answers
Most common cause of viral meningitis in May through November - CORRECT
ANSWER - enteroviruses
This virus can cause viral meningitis year round (think, outside of May to November) -
CORRECT ANSWER - HSV-1 and HSV-2 but HSV-2 more common
Leads to a flaccid paralysis with meningitis. Can cause death. Mosquito vector (hence, summer
months) - CORRECT ANSWER - West Nile Virus
Fever, rash, and mononucleosis-like syndrome with a viral meningitis - CORRECT
ANSWER - HIV
Lab test to confirm suspected West Nile Virus - CORRECT ANSWER - CSF IgM
Viral meningitis symptoms - CORRECT ANSWER - headache, fever, nuchal rigidity,
photophobia, nausea, vomiting, myalgias, pharyngitis, maculopapular rash, and cough
Role of gram staining in meningitis assessment - CORRECT ANSWER - Great if it comes
back positive (although this is in less than 5% of cases): leads you immediately to a gram +,
bacterial meningitis. Otherwise further workup of CSF (glucose, protein and pressure analysis)
and possible PCR is needed.
In what cases is an increased CSF opening pressure predicted - CORRECT ANSWER -
Bacterial and fungal (also +/- in viral)
In what cases is an increased protein in CSF expected? - CORRECT ANSWER - All 3
types of meningitis (possibly normal in viral)
, In what cases is gram stain positive in CSF? - CORRECT ANSWER - Gram positive
bacterial infection (but only 60-90% of even the gram + infections, not counting the gram
negatives)
In what cases are the CSF glucose expected to be low? - CORRECT ANSWER - Bacterial
meningitis and fungal (it eats the glucose)... also the same instances when increased CSF
opening pressure could be noted)
What types of meningitis show a pleocytosis of lymphocytes? - CORRECT ANSWER -
Viral and fungal
What types of meningitis show a pleocytosis of PMNs? - CORRECT ANSWER - bacterial
Why do you sometimes see a predominance of PMNs / leukocytes in VIRAL meningitis? -
CORRECT ANSWER - Early in infections PMNs are higher, dont be mislead on this
because lymphocytes can predominate later...
Three mosquito borne viral meningitis types - CORRECT ANSWER - St. Louis,
California, West Nile
Common signs of bacterial meningitis - CORRECT ANSWER - Acute meningeal signs:
fever, nuchal rigidity and AMS
Most common type of bacterial meningitis - CORRECT ANSWER - streptococcus
pneumoniae
Two previously common causes of bacterial meningitis, before conjugate vaccines - CORRECT
ANSWER - Haemophilus Influenzae and Neisseria meningitis
