Name: Tom Dawes

Theme: CNS Infection

OPTION LIST

A	Acute bacterial meningitis	I	TB meningitis
B	Acute leptomeningitis	J	Toxoplasmosis
C	Acute viral meningitis	K	Viral Encephalitis
D	Cerebral abscess	L
E	Prion disease (CJD)	M
F	Encephalomyelitis	N
G	Myelitis	O
H	Polio	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. A 24 yr old male is brought to A&E by his distressed girlfriend. They had just returned from a 2 week stay in Scotland when her boyfriend began to feel generally unwell. Since then he has become hyperactive and becomes uncontrollable when he sees or even hears water with jerky head and body movements. On examination he is severely dehydrated and you notice a small bite mark on his shoulder. You also notice ptyalism.

2. A 56 yr old male presents with fever, vomiting and seizures. Examination reveals a well established ear infection and there is a ‘ring-enhancing’ lesion on the MRI of his brain.

3. A 1 yr old child is brought into A&E by his mother. She has noticed he has a fever and is now becoming increasingly restless and will not stop screaming. He has a non-blanching rash on his thigh.

4. An 18 yr old student comes in feeling ‘pretty lousy and aching all over’. She is wearing dark glasses and complains of a stiff neck. CSF examination reveals a normal CSF/blood glucose ratio and 0.7 g/L protein with a lymphocyte count of 15

5. A 70 yr old man presents with his wife. She complains that he has become increasingly forgetful and now she is unable to understand what he says. On examination you notice some ataxia and sudden spasms of his muscles. An EEG shows periodic sharp waves.

ANSWERS

1. K

2. D

3. A

4. C

5. E