Pathology EMQ template.

Name: Umar Chaudhry

Theme: CNS Infection & Meningitis

 

OPTION LIST

 

A	Brain abscess	I	Mycobacterium tuberculosis
B	Creutzfeldt-Jakob disease (CJD)	J	Neisseria meningitides
C	Cryptococcus neoformans	K	Staphylococcus aureus
D	Echovirus 9	L	Streptococcus pneumonia
E	Escherichia coli	M	Treponema pallidum
F	Haemophilus influenzae	N
G	Herpes simplex type 1	O
H	Leptospira interrogans	P

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. CSF microscopy of a 34-year old Indian gentleman reveals lymphocytosis, a high protein content and low CSF glucose. A Ziehl-Nielsen stain of the CSF identifies acid-fast bacilli.

 

 

2. A 31-year old woman presents to A&E complaining of marked light photosensitivity, neck stiffness and a throbbing headache. She later informs you that she is HIV positive and has not been regularly taking her fluconazole medication. You do not perform a lumbar puncture after reading her hospital notes and notice that she was admitted for something quite similar but more severe a month ago.

 

 

3. A 48-year old woman presents with a 48-hour history of fever, headache, vomiting and a stiff neck. She had dental surgery last week and is also complaining of shooting pain in the mouth. Lumbar puncture was not performed due to possible risk of uncal herniation.

 

 

4. A 3-year old boy presents with an acute history of vomiting, irritability and a high-grade fever. You also notice a petichial rash on his thigh. CSF examination reveals increased leukocytes with a 90% predominance of polymorphs, with a high protein but low glucose content.

 

 

5. A 57-year old gentleman presents with his wife, who informs you that her husband has had remarkable memory loss, personality changes and ataxia over the past 6 weeks. She is worried about Alzheimer’s disease but you are more worried when CSF examination reveals 14-3-3 protein.

 

 

 

ANSWERS

1. I

2. C

3. A

4. J

5. B