MCQs on Encephalitis, diagnosis and treatment (with clinical case): Medical microbiology

                          MCQs on Encephalitis, diagnosis and treatment

1. A 29-year-old male presents to the emergency department with a sudden onset of symptoms. He appears confused and disoriented, with slurred speech and muscle weakness. His family members report that he had a high fever and severe headache for the past few days. They also noticed that he had developed a rash on his chest.

The patient has no significant medical history and is generally in good health. He mentions that he had recently returned from a camping trip in a wooded area.
Physical examination is done by the healthcare provider, temperature is 101.4°F, blood pressure is 130/80 mm Hg, and oxygen saturation is 98% on room air. The patient appears disoriented and confused, with difficulty answering questions. Neurological examination reveals muscle weakness, particularly in the limbs. Neck stiffness is present.

Laboratory tests reveal blood test with an elevated white blood cell count (leukocytosis). Cerebrospinal fluid analysis indicates an increased white blood cell count, elevated protein levels, and a normal glucose concentration. Imaging studies, including a CT scan and MRI, show no acute intracranial abnormalities. Based on the patient's clinical presentation, neurological symptoms, and cerebrospinal fluid findings, he is diagnosed with viral encephalitis. 

The patient is started on empiric antiviral therapy to cover a broad spectrum of viral pathogens that can cause encephalitis. Supportive care is provided to manage his fever, dehydration, and neurological symptoms. Intravenous fluids are administered to maintain hydration.

Which of the following is a common cause of viral encephalitis in the United States?

a. Influenza    

b. Kalazar

c. Malaria

d. Polio

2. What is the primary mode of transmission of the herpes simplex virus (HSV) leading to viral encephalitis?

a. Contaminated food and water

b. Mosquito bites  

c. Respiratory droplets

d. Sexual contact

3. Which cerebrospinal fluid (CSF) finding is typical in viral encephalitis?

a. Clear and colorless appearance

b. Decreased white blood cell count

c. Elevated glucose levels

d. Elevated protein levels

4. Which of the following is a potential complication of encephalitis that involves inflammation of the membranes surrounding the brain and spinal cord?

a. Appendicitis

b. Gastritis

c. Meningitis    

d. Pneumonia

5. What is the most common vector responsible for transmitting encephalitis viruses such as West Nile virus?

a. Flies

b. Mosquitoes

c. Spiders

d. Ticks

6. Which of the following is NOT a common symptom of encephalitis?

a. Hearing loss

b. High fever

c. Muscle weakness

d. Skin rash  

7. Which of the following Herpes virus is rare in humans but can cause fatal encephalitis?

a. Epstein-Barr Virus (EBV)

b. Herpes B virus       

c. Herpes Simplex virus 1 and 2 

d. Varicella-Zoster Virus (VZV)

8. Which of the following parasite (brain eating amoeba) is rare but can cause fatal meningoencephalitis in humans?

a. Aspergillus fumigatus

b. Giardia lamblia

c. Mycoplasma pneumoniae

d. Naegleria fowleri

9. Which of the following vector is responsible for the transmission of Japanese encephalitis virus into humans?

a. Aedes mosquitoes

b. Anopheles mosquitoes

c. Culex mosquitoes

d. Ixodes ticks

10. Which of the following gram positive bacteria can cause central nervous system infection leading to encephalitis?

a. Listeria monocytogenes

b. Legionella pneumophila

c. Mycobacterium tuberculosis

d. Mycoplasma pneumoniae

Answers: 

1. a. Influenza

2. c. Respiratory droplets 

3. b. Elevated protein levels

4. c. Meningitis

5. b. Mosquitoes

6. d. Hearing loss

7. b. Herpes B virus

8. d. Naegleria fowleri

9. c. Culex mosquitoes

10. a. Listeria monocytogenes