Deck 26: Nervous System Infections

Question 1

The limited type of leprosy in which cell-mediated immunity suppresses proliferation of the bacilli is called

A) lepromatous.
B) limited.
C) immune.
D) tuberculoid.
E) Hansen's.

Answer 1

D

Question 2

The meningococcus attaches to the mucous membrane via ________.

A) flagella
B) pili
C) cilia
D) a capsule
E) axial filaments

Answer 2

B

Question 3

Meningococcal meningitis is typically acquired through the

A) respiratory tract.
B) genitourinary tract.
C) gastrointestinal tract.
D) skin.
E) any of these.

Answer 3

A

Question 4

The leading cause of bacterial meningitis in adults is

A) Escherichia coli.
B) Haemophilus influenzae.
C) Streptococcus pneumoniae.
D) Neisseria meningitidis.
E) Mycoplasma pneumoniae.

Question 5

The cavities inside the brain are termed

A) sinuses.
B) ventricles.
C) cavities.
D) sulci.
E) gyri.

Question 6

Identification of the various strains of N. meningitidis is through

A) Gram staining.
B) serogrouping.
C) fluorescent antibodies.
D) titering.
E) signs and symptoms.

Question 7

Mycobacterium leprae has a generation time of

A) 12 days.
B) 6 hours.
C) 1 day.
D) 20 minutes.
E) 12-13 hours.

Question 8

The nerves that carry information to the central nervous system (CNS) are termed

A) motor nerves.
B) endocrine nerves.
C) sensory nerves.
D) cerebrospinal nerves.
E) central nerves.

Question 9

To determine the causative agent of a central nervous system (CNS) infection, a sample is taken from the

A) cerebrospinal fluid.
B) arterial blood.
C) venous blood.
D) urine.
E) ventricles.

Question 10

Leprosy is

A) an infectious disease caused by a virus.
B) a disease of the blood.
C) also known as Hansen's disease.
D) always fatal.
E) acquired by droplet transmission.

Question 11

The nervous system typically

A) is sterile.
B) has a small number of normal microbiota.
C) contains Gram-positive bacteria.
D) contains a small number of viruses.
E) has transient microbiota.

Question 12

The incubation period of leprosy is

A) 1 week.
B) 3 weeks.
C) 3 months.
D) 3 or more years.
E) over 10 years.

Question 13

The membranes that cover the surface of the brain and spinal cord are known as the

A) neurolemma.
B) dura mater.
C) meninges.
D) collagen.
E) sarcolemma.

Question 14

Which is True of listeriosis?

A) It is a foodborne disease.
B) It may result in meningitis.
C) It is usually asymptomatic in healthy people.
D) It is caused by an organism that can grow at refrigerator temperatures.
E) All of the choices are correct.

Question 15

Epidemics of meningitis appear to involve

A) Streptococcus pneumoniae.
B) Haemophilus influenzae.
C) Neisseria meningitidis.
D) Streptococcus pyogenes.
E) Staphylococcus aureus.

Question 16

An infection of the membranes covering the brain is called

A) encephalitis.
B) meningitis.
C) arachnitis.
D) ventriculitis.
E) duramitis.

Question 17

The only known human pathogen that preferentially attacks the peripheral nerves is

A) N. meningitidis.
B) polio virus.
C) M. leprae.
D) E. coli.
E) H. leprae.

Question 18

The primary source of central nervous system (CNS) infections is through the

A) bloodstream.
B) genitourinary system.
C) skin.
D) nerves.
E) gastrointestinal tract.

Question 19

The central nervous system (CNS) may become infected through the

A) bloodstream.
B) nerves.
C) extensions from bone.
D) ventricles.
E) bloodstream, nerves, AND extensions from bone.

Question 20

The central nervous system is made up of the

A) brain and spinal cord.
B) spinal cord and spinal nerves.
C) sympathetic and parasympathetic system.
D) brain and endocrine organs.
E) spinal nerves and meninges.

Question 21

In rabies, the virus multiplies in one kind of cell then binds to receptors in the

A) neuromuscular region.
B) spinal cord.
C) respiratory area.
D) brain.
E) cerebrospinal fluid.

Question 22

Humans acquire the arbovirus that causes epidemic encephalitis by

A) the fecal-oral route.
B) human to human contact.
C) the bite of an infected mosquito.
D) contaminated food.
E) unprotected sex with an infected person.

Question 23

The transmission of M. leprae is by

A) direct human-to-human contact AND the fecal-oral route.
B) the fecal-oral route AND contact with contaminated blood products.
C) contact with contaminated blood products.
D) contact with infected nasal secretions AND the fecal-oral route.
E) direct human-to-human contact AND contact with infected nasal secretions.

Question 24

Which is True of the poliomyelitis virus?

A) non-enveloped AND single-stranded DNA
B) non-enveloped AND single-stranded RNA
C) enveloped AND single-stranded DNA 
D) enveloped AND double-stranded RNA
E) enveloped AND single-stranded RNA

Question 25

Characteristic inclusion bodies formed in cells of organisms infected with rabies are called

A) Negri bodies.
B) metachromatic bodies.
C) polyphasic bodies.
D) Koplik spots.
E) rhabdobodies.

Question 26

The principal mode of transmission of rabies virus is through

A) blood.
B) fomites.
C) saliva.
D) pus.
E) insect bites.

Question 27

The early symptoms of rabies generally begin

A) 1 day after viral entry.
B) 1-2 months after viral entry.
C) 6 months after viral entry.
D) 1 year after viral entry.
E) immediately after viral entry.

Question 28

Painful spasms of the throat triggered by swallowing or the sight of water is called

A) hydrophobia.
B) hydrophagia.
C) tetany.
D) paralysis.
E) aquaphobia.

Question 29

M. leprae may infect

A) skunks.
B) iguanas.
C) armadillos.
D) raccoons.
E) birds.

Question 30

Food contaminated with Clostridium botulinum often

A) appears normal.
B) looks odd.
C) smells bad.
D) tastes bad.
E) is frothy.

Question 31

Viral central nervous system infections may result in

A) meningitis.
B) encephalitis.
C) poliomyelitis.
D) rabies.
E) All of the choices are correct.

Question 32

Which is True about C. botulinum?

A) It is aerobic.
B) It does not grow well below pH 4.5.
C) It may form spores.
D) It produces an enterotoxin.
E) It is Gram-negative.

Question 33

The poliomyelitis virus is in the picornavirus family in the subgroup

A) adenoviruses.
B) enteroviruses.
C) arboviruses.
D) dermotrophs.
E) retroviruses.

Question 34

Which is True of the Clostridium botulinum toxin?

A) It is heat-resistant.
B) It is a neurotoxin.
C) It stimulates nerve to muscle signal transmission.
D) It causes spastic paralysis.
E) All the choices are correct.

Question 35

Which animal is used as an early warning system for viral encephalitis?

A) armadillos
B) chickens
C) mice
D) foxes
E) hawks

Question 36

The poliomyelitis virus appears to selectively destroy

A) sensory nerve cells.
B) mixed nerve cells.
C) autonomic nerve cells.
D) motor nerve cells.
E) muscle cells.

Question 37

Intestinal botulism, especially in infants, has been linked to ingestion of

A) seafood.
B) honey.
C) milk.
D) applesauce.
E) syrup.

Question 38

The incubation period of rabies is partially determined by

A) age of the patient AND length of journey from the bite site to the brain.
B) season of the year that the disease is acquired AND length of journey from the bite site to the brain.
C) length of journey from the bite site to the brain AND the amount of virus introduced into the wound.
D) the amount of virus introduced into the wound AND season of the year that the disease is acquired.
E) season of the year that the disease is acquired AND the age of the patient.

Question 39

The symptom at the site of an animal bite that suggests rabies as a possible diagnosis is

A) failing to heal.
B) blue-green pus.
C) tingling or twitching.
D) inflammation with high fever.
E) blisters.

Question 40

The polio viruses usually enter the body through

A) the oral route.
B) contaminated blood.
C) cuts in the skin.
D) the respiratory route.
E) insect bites.

Question 41

What underlying infection should a physician immediately suspect when confronted with a patient with confirmed cryptococcal meningoencephalitis caused by Cryptococcus neoformans, and why?

A) Influenza infection. Influenza virus and C. neoformans are frequently transmitted together in respiratory droplets.
B) HIV infection/disease. People with healthy immune systems generally fend off this fungal infection before it becomes clinically symptomatic.
C) Varicella zoster virus (chicken pox). During the incubation period for chicken pox, C. neoformans has an increased ability to colonize the respiratory tract.
D) Syphilis. This sexually-transmitted illness depletes CD4+ helper T cells that are necessary to directly attack the fungal infection of C. neoformans.
E) Primary amebic meningoencephalitis. The causative agent of PAM also causes cryptococcal meningoencephalitis.

Question 42

The more severe form of African sleeping sickness is called the

A) Gambian form.
B) Rhodesian form.
C) Guyanan form.
D) Brazilian form.
E) Zambian form.

Question 43

Mycobacterium leprae is only grown in living cells.

Question 44

Viral meningitis is much more common than bacterial meningitis.

Question 45

Central nervous system (CNS) diseases caused by fungus may occur in

A) cancer patients.
B) diabetics.
C) AIDS patients.
D) immunosuppressed people.
E) All of the choices are correct.

Question 46

Corneal implants have been implicated in a few cases of

A) botulism.
B) trypanosomiasis.
C) Creutzfeldt-Jakob.
D) scrapie.
E) encephalitis.

Question 47

Why can an infection in the brain's ventricles usually be detected in spinal fluid obtained from the lower back (lumbar region)?

A) Cerebrospinal fluid (CSF) originates in the ventricles, but percolates over and around the brain and spinal cord.
B) There is a high degree of vascularity that exists, allowing easy transfer of bacteria in the cerebrospinal fluid (CSF) and the blood.
C) There is a set of lymph nodes specifically in place to drain the cerebrospinal fluid (CSF) from the ventricles. They are found in the lumbar region of the spinal column.
D) This is an incorrect statement. Since the central nervous system (CNS) is a protected site due to the blood-brain barrier, there can never BE an infection in the ventricles.
E) When ventricles are infected, the brain reacts by pumping the causative pathogens into the CFS so that they can be removed by the immune system.

Question 48

Why are infants at risk of developing botulism after they ingest honey, but adults are not?

A) Bees cultivate C. botulinum bacteria within their hives as a food source. This gets mixed in with the honey they make, and is ingested by infants they are given food containing honey. Adults seldom eat honey, so are not exposed to this organism.
B) The infant digestive tract is immature and is extremely susceptible to the effects of botulism toxin which found in the honey in relatively high levels. The adult digestive tract is immune to the effects of botulinum toxin because of M cells and Peyer's patches.  
C) The spores of C. botulinum produce a strong endotoxin. This endotoxin has little effect on adults because their immune system is fully developed. Infants, however, do not have a fully developed immune system and therefore far more susceptible to the toxin than adults.
D) Honey can contain C. botulinum endospores. These may germinate in the intestines of infants that have eaten it, leading to colonization and pathogenesis as the bacteria begin forming botulism toxin. Adults' normal intestinal microbiota will out-compete the new microbes.
E) Honey can contain C. botulinum endospores. These may germinate in the intestines of adults that have eaten it. The bacteria are then sampled by M cells within the adult intestinal tract, leading to the development of botulism. Infants do not have any M cells in their tract.

Question 49

Which is True about prions?

A) They are made of DNA and protein AND they are a normal brain protein that has folded differently.
B) They cause a degenerative brain condition AND they are a normal brain protein that has folded differently.
C) They cause a degenerative brain condition AND they are naked pieces of DNA.
D) They cause a degenerative brain condition AND they are naked pieces of RNA.
E) they cause fatal neurodegenerative disease AND they are naked pieces of RNA or DNA.

Question 50

Why would the Sabin oral polio vaccine need to be eliminated after eradication of the polio virus?

A) Since it is a live, attenuated viral vaccine, there's always the chance it could revert back into a pathogenic state by mutation. This would introduce new strains still capable of causing the illness into human populations, preventing elimination.
B) The Sabin vaccine is cheaper than the Salk (killed virus) vaccine, but it isn't as effective at producing a protective response. We'll need to shift to the more effective Salk vaccine worldwide eventually to complete the eradication process.
C) The Salk vaccine is far cheaper than the Sabin vaccine. To effectively eradicate polio, we'll need to shift all of our resources into the cheapest and easiest to deliver vaccine possible. That is the Salk vaccine.
D) The Sabin vaccine can only be administered to human beings. We need to vaccinate bird populations as well to effectively control the spread of polio. Birds are a natural reservoir for the virus.
E) There will be no need to eliminate the polio vaccine after polio virus eradication. Both the Sabin and the Salk vaccines will still be essential.

Question 51

Inflammation of the membranes covering the central nervous system (CNS) is called meningitis.

Question 52

All cases of paralytic polio acquired in the U.S. between 1980 and 1999 were caused by Salk's polio vaccine.

Question 53

Naegleria fowleri may cause

A) meningitis.
B) primary amebic meningoencephalitis.
C) African sleeping sickness.
D) AIDS.
E) primary amebic microencephalitis.

Question 54

Prions are small single-stranded pieces of RNA.

Question 55

Stained smears of the surface of the eye might be useful in diagnosing

A) influenza.
B) rabies.
C) herpes.
D) polio.
E) encephalitis.

Question 56

The initial symptoms of bacterial meningitis are the same regardless of the causative agent.

Question 57

Cryptococcal meningoencephalitis caused by Cryptococcus gattii differs from the general pattern of fungal central nervous system (CNS) disease by occurring in

A) otherwise healthy people.
B) children.
C) AIDS patients.
D) immunosuppressed people.
E) animals only.

Question 58

Meningoencephalitis and African sleeping sickness are both caused by protozoans.

Question 59

African sleeping sickness is transmitted by

A) ticks.
B) black flies.
C) Aedes mosquitoes.
D) tsetse flies.
E) tsetse mosquitoes.

Question 60

Death from botulism is usually due to respiratory paralysis.

Question 61

Which of the following is NOT a characteristic of meningococcus?

A) It is a diplococcus.
B) It is an encapsulated bacterium.
C) It can vary its surface antigens.
D) It uses pili for attachment to mucosal epithelium.
E) Antigenic variation prevents the development of a vaccine.

Question 62

Which statement is would NOT apply to CSF taken from a person you suspect has bacterial meningitis?

A) The CSF would be cloudy and opaque rather than pale yellow and clear.
B) The CSF would have high protein levels compared with blood.
C) The CSF would contain neutrophils.
D) The CSF would have low glucose levels compared with blood.
E) The CSF would be bloody and opaque rather than pale yellow and cloudy.

Question 63

Why do Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae seldom cause meningitis in newborns?

A) Infants seldom come into contact with these pathogens.
B) These pathogens are unable to colonize infants.
C) Infants are protected by maternal IgM against these pathogens.
D) Infants are protected by maternal IgG against these pathogens.
E) Infants are vaccinated against these pathogens.

Question 64

Please select the True statement regarding Haemophilus influenzae.

A) It is a virus.
B) All strains are encapsulated.
C) It frequently causes meningitis in adults.
D) Polysaccharide antigen from type b is used in vaccination.
E) It is a highly motile spirochete.

Question 65

Why is it important to learn about rabies, considering that only a few cases occur in the United States each year?

A) The U.S. isn't the entire world. Rabies might be more common in other areas, and it's important to understand due to the fact that this disease is nearly always fatal.
B) The only reason why rabies isn't common in the U.S. is due to our lack of interaction with animal carriers. We could very easily have an outbreak of rabies if we don't know the warning signs to watch for that we've learned about by studying the virus and disease.
C) Rabies can never be completely eliminated-it has too many different animal reservoirs/carriers.  As such, we need to remain constantly aware of how to protect human populations, both by preventing and treating the illness. We can only do that by learning about it.
D) All of the answer choices are correct.
E) None of the choices is correct.

Question 66

Why can't botulism be transmitted from person to person?

A) The disease is caused by eating spores that germinate into vegetative cells that produce toxin.
B) The disease is a toxin-mediated disease; it is caused by ingestion of food contaminated with botulinum toxin produced under anaerobic conditions by Clostridium tetani.
C) The disease is caused by eating spores that germinate into vegetative cells that produce toxin AND people with botulism die before they can transmit the disease to others.
D) The disease is caused by ingestion of food contaminated with botulinum toxin AND the disease is caused by eating spores that germinate into vegetative cells that produce toxin.
E) Botulism is a toxin-mediated blood-borne disease AND people with botulism die before they can transmit the disease to others.

Question 67

Which statement regarding the anatomy and physiology of the nervous system is False?

A) The bloodstream is the primary source of CNS infections, but these infections are rare because it is difficult for microbes to move from the bloodstream into the brain.
B) There is no normal microbiota in the central nervous system, while the peripheral nervous system contains a few common bacterial genera.
C) Information in the form of electrical impulses enters the neuron via the dendrites, and exits that neuron via the axon, from where they enter another cell.
D) Neurons communicate via chemicals called neurotransmitters; these are released by one cell and bind to receptors on the membrane of the next cell.
E) The central nervous system is protected by bone and membranes called meninges, while nerves in the peripheral nervous system do not have these protective coverings.

Question 68

Streptococcus pneumoniae and Haemophilus influenzae are frequently part of the normal microbiota of the nasal passages and throat. 

Question 69

What sign would differentiate meningococcal meningitis from pneumococcal meningitis?

A) Petechiae are seen in meningococcal meningitis but not in pneumococcal meningitis.
B) Petechiae are seen in pneumococcal meningitis but not in meningococcal meningitis.
C) Headache and neck stiffness are experienced with meningococcal meningitis but not with pneumococcal meningitis.
D) Headache and neck stiffness are experienced with pneumococcal meningitis but not with meningococcal meningitis.
E) It is impossible to differentiate between pneumococcal meningitis and meningococcal meningitis.

Question 70

The PPSV23 vaccine may protect against pneumococcal pneumonia, pneumococcal meningitis, and otitis media. 

Question 71

For what is a lumbar puncture used?

A) To release pressure in the meninges caused by viral infection.
B) To obtain a sample of the cerebrospinal fluid for examination.
C) To obtain small pieces of meninges for biopsy.
D) To prevent movement of pathogens from CSF to the meninges.
E) To examine the spinal cord for inflammation.

Question 72

You're a famous eye surgeon, specializing in corneal transplants. Given your choice, would you rather use a cornea from a 20-year old person, or one from a 60-year old person (assuming there are no optical defects due to age) for transplantation, and why?

A) The 60-year old cornea. If the person has gone 60 years with no optical defects, this is a very good organ for transplantation. The 20-year old cornea may have defects that simply haven't become apparent yet.
B) The 20-year old cornea. Younger is always better when dealing with tissue transplants. You want to give the transplant the longest possible time for survival in the recipient.
C) The 20-year old cornea. While extremely rare, it may be possible to transmit prions through corneal transplants. It's less likely that a younger cornea would have become contaminated by prions than the older cornea.
D) The 20-year old cornea. There are a variety of agents that can hide in corneal tissues and that might cause disease. It's far more likely that the older cornea would be harboring one or more of these pathogens than the younger cornea.
E) The 20-year old cornea. The recipient of the cornea is much less likely to reject the younger tissue, which will have fewer antigens on it. The older cornea is more likely to be rejected by the recipient.

Question 73

Which of the following mostly causes typically pneumonia but may also cause meningitis?

A) Mycoplasma pneumoniae
B) Klebsiella pneumoniae
C) Mycoplasma meningitidis
D) Neisseria meningitidis
E) Streptococcus pneumoniae

Question 74

Identify the meninges from closest to the brain to furthest away:
1) dura mater
2) pia mater
3) arachnoid mater

A) 1, 2, 3
B) 3, 2, 1
C) 2, 3, 1
D) 3, 1, 2, 3
E) 1, 3, 3, 1

Question 75

The most common cause of meningitis in newborn infants is Streptococcus agalactiae, a

A) Gram-positive group A streptococcus.
B) Gram-negative group B streptococcus.
C) fungus that often colonizes a woman's vagina.
D) group A streptococcus that often colonizes a woman's vagina.
E) group B streptococcus that often colonizes a woman's vagina.

Question 76

Why is PPSV23 not an effective vaccine for protecting children against pneumococcal meningitis?

A) Children never get pneumococcal meningitis. They get typically get meningococcal meningitis, which is less severe.
B) The vaccine contains capsular polysaccharides, and children do not mount a strong immune response against T-independent antigens. 
C) PPSV23 is an attenuated vaccine and children cannot be given this type of vaccine because they are high risk of contracting the disease rather than being protected from it.
D) Pneumococcus causes pneumonia in children, not meningitis. Children could receive this vaccine but it is unnecessary because pneumonia is less severe than meningitis.
E) The vaccine contains capsular polysaccharides, and children do not mount a strong immune response against T-dependent antigens. 

Question 77

Which of these descriptions does NOT apply to the pathogenesis of meningitis? 

A) Vasodilation from inflammation results in accumulation of fluid, causing brain swelling and nerve damage.
B) Vasodilation disrupts the blood-brain barrier and allows neutrophils and proteins to enter the CSF.
C) Inflammation results in the formation of small blood clots that block capillaries and interrupt blood supply, leading to cell death.
D) Fever causes the blood pressure to increase significantly, forcing lymph fluid into the meninges and causing brain swelling.
E) Inflammation impedes normal outflow of CSF, causing it to accumulate and press the brain against the skull.

Question 78

Which statement about viral meningitis is True?

A) There are effective vaccines to protect against viral meningitis.
B) Paralysis is a common sign of viral meningitis.
C) The causative agents do not survive well in the environment.
D) Transmission of the causative agent is by the fecal-oral route.
E) Recovery is seldom complete-permanent disabilities usually occur.

Question 79

A pathologist claims it's much easier to determine the causative agent of meningitis than that of an infection of the skin or intestines. Is this True? Why or why not?

A) It's not True. An infection is an infection, and it's always difficult to track down the exact causative agent. The organ system involved in the illness has nothing to do with identification of the causative agent.
B) It's True. The CNS is generally microbe free, whereas the skin and intestines have a diverse normal microbiota. Separating out a pathogenic causative agent from the normal microbiota in these areas would be much harder to do than in the CNS.
C) It's not True. The ventricles of the brain can provide a direct route for microbes to enter the CNS from the bloodstream. Therefore, it would be just as likely to find a pathogenic microbe in the CNS as it would be in the skin or intestines.
D) It's True. There are only 1 or 2 microbes that can cause meningitis, yet there are hundreds (if not thousands) that can cause skin/intestinal infections. This makes it much easier to determine the causative agent for a case of meningitis.
E) It is not True. It is almost impossible to obtain a sample of cerebrospinal fluid, which is required to diagnose meningitis. It is far simpler to obtain a sample from the skin or intestines, so it is easier to diagnose diseases of these systems.

Question 80

Which statement regarding meningitis is False?

A) If bacterial meningitis is suspected, a person is given broad-spectrum antibiotics immediately, without waiting for identification of the causative organism.
B) Bacterial causative agents of meningitis are transmitted through respiratory droplets, while viral agents of the disease may also be transmitted via the fecal-oral route.
C) The cerebrospinal fluid of people with either viral meningitis or bacterial meningitis is cloudy and opaque rather than being clear and pale yellow in color.
D) Meningitis is a relatively rare disease, because it is very difficult for the causative agents to cross the blood-brain barrier.
E) Vaccines protect against the most important types bacterial meningitis but prevention of viral meningitis depends on increased hand washing and avoiding crowded areas.