NS quiz question bank 2015

(For quiz 4 only)

Infectious diseases of the nervous system
1. The main portal of the pathogens to enter CNS is . What are the other portals for
pathogens to entre CNS?

For pathogens of the CNS the main portal of entry is bloodstream

Other portal of entry include:
o via peripheral nerves.
o Infections from adjacent areas, notably ear and upper respiratory tract infections can spread to the CNS.
(The major example being meningitis)
o Head injuries

2. What are the possible consequences of a CNS infection?

CNS infections are uncommon. but can be serious: profound changes in nervous system function;
permanent neurological damage; or fatality.

3. The inflammation of the meninges is called meningitis and the inflammation of the brain is
called .
Meningitis is inflammation of the meninges.
Encephalitis is inflammation of the brain itself and most cases are viral.

4. Bacterial meningitis should be treated as a medical emergency. True/false

BACTERIAL MENINGITIS treated as a medical emergency.

5. Coccidus meningitidis (‘meningococcal meningitis’) is one of the main causative organisms of

meningitis. True/false

The main causative organisms bacterial meningitis

• Neisseria meningitidis (“meningococcal meningitis”)
• Haemophilus influenzae (but now part of standard vaccination)
• Streptococcus pneumoniae (“pneumococcus”)

6. Meningitis can be the result of the spread of respiratory tract infection. True/false

o Infections from adjacent areas, notably ear and upper respiratory tract infections can spread to the CNS.
(The major example being meningitis)

7. What is the population that is at high risk of developing meningitis?

Groups at risk of meningitis
• Toddlers and infants
• Elderly and immuno-compromised patients
• People with head injury; or after head surgery.
8. Please list 3 symptoms/signs of meningitis.
Signs and symptoms include:
• headache
• fever
• muscle rigidity leading to neck stiffness
• neurological changes (behavioural, cognitive, manifestations of fluid and electrolyte imbalance)
• The patient (or the person with the patient) may report recent respiratory tract infection or the patient
may currently manifest the signs of such an infection.

9. Microbial analysis of the by is the single most important definitive

diagnosis for meningitis.

• Definitive diagnosis: microbial analysis of the cerebrospinal fluid collected by lumbar puncture.

10. Please briefly describe how nasal infection leads to meningitis.

The pathophysiology of meningitis
• Commonly the organisms will colonise the nasal cavity and/or throat =>From there they can enter the
bloodstream.
• Pathogenic strains of these organisms possess mechanisms that allow them to cross the blood-brain
barrier.
• In the CSF the organisms may replicate leading to inflammation (associated with increased vascular
permeability and white blood cell infiltration).
• Other vascular problems can lead to local ischaemia
• also direct bacterial damage or bacterial toxins can bring about the disease.

11. For bacterial meningitis, antibiotics need to be administered within minutes of arrival to the
ER.
12. The antibiotics for meningitis must be able to cross the .

Bacterial meningitis: treatment

• Being bacterial, antibiotics are administered.
o They are delivered IV and within 30 min of arrival.
o “Delay in initiation of antimicrobial therapy…can result in poor outcomes”
o Apart from (in the first instance) being broad spectrum: the antibiotic must be able to cross the blood-
brain barrier
o Given that inflammation is the principal source of the pathophysiology: a common adjunct is anti-
inflammatory drugs

13. Vaccines are available to prevent bacterial meningitis. True/false

Bacterial meningitis: Vaccine

• Given that the pathogens are sometimes present in a persons’s respiratory tract, the vaccine against H.
influenzae is standard in Australia.
• Vaccination against N. meningitides is also part of the standard program. The issue here is that there are
several strains (t types) of this organism and this development is ongoing
• Vaccination against S. pneumoniae is recommended for high risk groups (asplenic individuals, non-
indigenous people > 65 yrs, Aboriginals and Torres Strait islanders > 50 yrs) for its respiratory benefits.
14. Prophylactic antibiotics for bacterial meningitis can be considered for those , or
. (intended to prevent disease)

Prophylactic antibiotics
• When a case has been identified these are given to intimate contacts of the infected person.
o Also they are administered to Group B Streptococcus positive pregnant women.

15. The most common causes of viral Encephalitis (inflammation of the brain) in Australia are
(pathogen name).

That is an arthropod-borne viruses.

16. Supportive therapy is essential to control the neurological symptoms in patients with viral
encephalitis. True/false

• Hospitalisation and treatment with anti-virals, anti-inflammatory drugs & supportive therapy (to
deal with the neurological effects)

17. Vaccines are available to prevent encephalitis. True/false

• Vaccination for people living in endemic areas

18. are the dormant cells (hibernating) where Clostridium tetani and C. botulinum can
live for a long period of time in the soil.

• Both of these have causative organisms commonly found in soil (where they can persist as long-lived
dormant cells known as endospores) Clostridium tetani and C. botulinum, respectively.
19. The spores (a rounded resistant form adopted by a bacterial cell in adverse conditions) of
Clostridium tetani can get into a wound, associated with injuries such as, .

The spores get into a wound (associated with, for example: animal bite or a dirty sharp object).

20. Tetanus (a bacterial disease marked by rigidity and spasms of the voluntary muscles) is manifested
by over/under activity of both and nerves.

In the wound the spores germinate, bacteria grow and produce toxin.
o The toxin spreads through the body and onto CNS and blocks secretion by inhibitory neurons.
o This leads to over-activity of motor neurons and neurons of sympathetic nervous system as manifested by
muscle spasms.
21. Tetanus is manifested by muscle spasms/weakness. Please give an example of muscle disorders
in the patients with tetanus.
For example lockjaw: contraction of the masseter muscle (jaw); contraction of the facial muscles into a
sneer; and chronically flexed or extended limbs
22. is the first important step for the treatment of tetanus.

Wound cleaning is important

23. Tetanus is preventable by vaccination. True/false

Vaccination against tetanus infections is part of the standard immunisation programs

24. Botulism is not an infection, but , when the patient consumed food contaminated with
the botulism toxin.

This is not an infection as such it is food intoxication, that is: consumption of food contaminated with
the botulism toxin.

25. Botulism toxin inhibits release.

26. Botulism is manifested by muscle spasms/weakness.

The botulism toxin inhibits acetylcholine release and so leads muscle weakness/paralysis.

27. Botox is given medically to overcome muscle .

BOTOX® injections were intended for the treatment of various types of dystonia ( muscle spasms)

Stroke
28. Stroke is due to a sudden disruption of to a part of the brain.

stroke: A sudden disruption of the blood supply to a part of the brain

29. In the penumbra, the blood flow is stopped/reduced/unchanged /increased.

30. In the penumbra, the supply of oxygen and glucose is stopped/ reduced/unchanged /increased.

31. What is the most preventable cause of stroke?

Behavioural risk factors : Smoking / lack of exercise / Heavy drinking
Diet related risks: high fat / high salt
32. There are two types of stroke, and stroke.

• a blockage develops -Ischemic (80-85%)

• a blood vessel bursts -Haemorrhagic (5-10%)

33. Atrial fibrillation is one of the causes of ischemic stroke. True/false

Atrial fibrillation: make a quivering movement due to uncoordinated contraction of the
individual fibrils in the heart
The most common problem is narrowing of the arteries in the neck or head. This is most often
caused by atherosclerosis
Another cause of stroke is blood clots in the heart, which can occur as a result of irregular
heartbeat (for example, atrial fibrillation), heart attack, or abnormalities of the heart valves.
34. Deep vein thrombosis is one of the causes of haemorrhagic stroke. True/false

Deep venous thrombosis is a blood clot in the veins of the lower leg or thigh. Venous
thromboembolism (VTE) is a major cause of morbidity and mortality after acute ischemic stroke.

35. What are the two main causes of haemorrhagic stroke?

An aneurysm — a weak spot in a blood vessel wall that balloons outward — can lead to a
hemorrhagic stroke.( an excessive localized swelling of the wall of an artery)
Chronic high blood pressure may also weaken spots in the artery wall, making these spots more
prone to rupture.

36. How are the headache symptoms in the patients with stroke different from those with sleep
deficiency?
Sudden severe headache with unknown cause or unexplained change in the pattern of headaches
(stabbing sensation).
37. Transient ischemic attack is also called ‘mini stroke’. It is a real stroke. True/false
A TIA, or transient ischemic attack, is a temporary blockage caused by a blood clot.
TIA is sometimes referred to as “mini stroke” or “warning stroke,” because it can be a warning sign
of a future stroke.
38. When a patient with stroke comes to you, you will observe his face so that you can determine
whether .

Face. Ask for a smile. Does one side droop?

39. When a patient with a stroke comes to you, you will ask him to answer some questions so that
you can determine whether .

Speech. Can the person repeat a simple sentence? Does he or she have trouble or slur words?

40. When a patient with stroke comes to you, you will ask him to raise his arms so that you can
determine whether .

Arms. When raised, does one side drift down?

41. Mr Smith was sent to the ER by his daughter. He had a sudden onset of a severe headache for
four hours earlier when he was reading his morning newspaper. The headache was not relieved
by a couple of Panadol tablets. Half an hour after his arrival at the ER, he was diagnosed with
ischemic stroke.
1) To confirm the diagnosis of stroke, you would request a examination immediately.
When someone with stroke symptoms arrives in the ER
– determine which type: CT scan
2) Which of the images is suggestive of ischemic stroke?

a b
Ischemic Stroke

Hemorrhagic Stroke

3) Will you consider giving Mr Smith thrombolytic treatment immediately? Why?

Emergency treatment
• Aspirin: within 48h of onset
• thrombolytic therapy (if < 3hrs)

42. The early symptoms of brain herniation include , , and .

The most serious consequence of brain herniation due to brain haemorrhage is the compression
of brain stem/medulla (name of a brain structure), which contains and centres.
If this part is compressed, the patient can suffer sudden death.

Increased intracranial pressure pushes the brain out of position (projectile vomiting)
Compression of the oculomotor nerve is an early sign
 drop of eyelid and pupil dilation
 disabled eye movement
The medulla oblongata, is the lower half of the brainstem continuous with the spinal cord. The medulla
contains the cardiac, respiratory, vomiting and vasomotor centres dealing with heart rate, breathing and
blood pressure
43. Motor cortex damage leads to skeletal paralysis on the opposite/same side.

Motor cortex damage leads to contralateral (opposite) hemiplegia. Sensory cortex damage leads to
partial loss of sensation on arm and leg on the opposite side.
Neurodegenerative diseases
44. Neural degenerative disease is reversible. True/false

degenerative disease: Dementia - Permanent damage to the cerebral hemispheres

45. Neural degenerative disease is fatal. True/false

Degenerative diseases are progressive and eventually fatal

46. (name of a neurotransmitter) releasing neurons are affected in the patients with
Alzheimer’s disease.

Alzheimer’s disease: ACh releasing neurons affected

47. Alzheimer’s disease is manifested by the of the cortex.

48. Which brain lobes are affected and which brain lobe is intact(undamaged) in patients with
Alzheimer’s disease?

Alzheimer’s disease: Progressive shrinkage of cerebral cortex – especially frontal and temporal
lobes, occipital cortex no change

49. Please briefly describe the three stages of behavioural change in a patient with Alzheimer’s
disease?

• First: short-term memory loss

• Second: confusional stage – deterioration of higher learning functions, disorientation, impaired hygiene
and language use
• Third: incontinence, inability to recognize family and friends, loss of ability to speak

50. The changes in (name of a neurotransmitter) levels leads to Parkinson’s disease.

Dopamine
51. Why can’t dopamine be used to treat patients with Parkinson’s disease?
- cannot administer dopamine since it is water soluble and cannot cross the Blood Brain Barrier
52. The patients with Parkinson’s disease can have difficulties to stand up when they sit on a low
chair. True/false

causing involuntary movement

tremor at rest (pill rolling movement)
rigidity, mask-like face
stooped posture
difficulty initiating movement
slow movement, shuffling gait
dementia in 40 -50%

53. Which of the following drugs can cross the blood brain barrier and be cleaved into dopamine?
a. Levodopa
b. Carbidopa
c. Amantadine
d. Pergolide
e. Bromocriptine
 Levodopa which can cross the BBB
Carbidopa inhibits enzyme which breaks down Dopamine
54. The reduction of (neurotransmitter) level leads to Huntington’s disease?

–  reduction of GABA (gamma-aminobutyric acid) activity

55. The involuntary movements in patients with Huntington’s disease are normally repetitive.
True/false

Involuntary non-repetitive movements

56. Huntington disease can be inherited. True/false

Inherited: uncommon in those of Asian or African ancestry

57. Huntington chorea can be ameliorated by drugs to increase brain GABA levels.
True/false
• No specific treatment

Traumatic brain and spinal cord injury

58. Which of the injuries is manifested by a bruise to the cortical surface of the brain?
a. Concussion
b. Contusion
c. Diffuse axonal injury
d. Herniation
e. Laceration

Contusion – bruise to cortical surface of the brain.

59. The memory loss due to concussion is normally temporary/permanent.

Concussion – momentary loss of brain function. Recovery 24 hours. Symptoms (headaches,

insomnia, poor concentration and memory) may last for months.

60. The memory loss due to diffuse axonal injury is normally temporary/permanent.

Diffuse Axonal injury – Responsible for most cases of post traumatic dementia

61. The patients with rapid intracranial bleeding never wake up after the car accident.
True/false

Hematoma
- rapid bleeding and compression of the brain occurs from the expanding hematoma.
- rapid progression to unconsciousness
- Prognosis is excellent if removed before loss of consciousness occurs otherwise death may result
62. Please give an example of secondary injury in patients with brain injury.

Secondary injuries resulting from complicating processes:

- increased intracranial pressure
- ischemia
- edema
- infection
63. In a patient with spinal cord shock, the reflex activity would normally disappear.
True/false

- Spinal shock: Absence of reflexes which may last minutes to weeks - follows sporting injuries

64. Spinal cord injury always leads to a complete loss of both motor and sensory functions.
True/false

- complete/incomplete/segmental/tract

65. The loss of bladder and bowel control due to spinal shock is permanent.
True/false

- Spinal shock: Absence of reflexes which may last minutes to weeks - follows sporting injuries

66. The spinal injury at and above would normally result in the inability to breathe voluntarily.

- C4-C5: diaphragm, which allows breathing

67. Autonomic dysreflexia is manifested by an exaggerated response of the .

Autonomic dysreflexia: Injury above T6, exaggerated sympathetic reflex responses

68. A positive reaction of Sign is suggestive of spinal cord injury.

- Positive Babinski Sign: Indication of spinal cord damage - toes fan out

69. Blood pressure is increased in the patient with autonomic dysreflexia. True/false