Pathology EMQ template.

Name: Jennie Clough

Candidate number:

Theme: CNS infections and meningitis

OPTION LIST

A	Escherichia coli	I
B	Echovirus 9	J
C	Herpes simplex type 1	K
D	Leptospira interrogans	L
E	Mycobacterium tuberculosis	M
F	Neisseria meningitides	N
G	Staphylococcus aureus	O
H	Trepenema pallidum	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 2 year-old boy presents with a 6 hour history of fever, irritability and vomiting, and you notice a purpuric rash on his thigh. CSF shows a predominance of polymorphs with a low glucose, and a Gram stain identifies Gram negative diplococci.

2. A 2 month-old presents with a 2 day history of fever and chills. She had a throat infection in the previous week. CSF results show a predominance of mononuclear cells, and a normal glucose.

3. A 34 year-old known HIV positive male presents with a 4 day history of worsening lethargy and fluctuating consciousness. Neurological examination reveals a palsy of the III and VI cranial nerves. A Ziehl-Nielsen stain of the CSF identifies acid-fast bacilli.

4. A 26 year-old complains of two days of fever, headache and nausea. She appears confused and lethargic, and whilst in A + E has a seizure. A lumbar puncture is performed, but her CSF appears normal.

5. A 22 year-old keen windsurfer presents with yellow sclera and signs of meningism. For the past week he has been feeling “under the weather”, and has been complaining of headaches, muscle aches and a fever. CSF shows raised polymorphs and a low glucose, and spiral-shaped organisms are found.

ANSWERS

1. F

2. B

3. E

4. C

5. D