Here, Pretty Pigeon

A 24 year old white male was brought to the Emergency room complaining of headaches of one weekıs duration that were getting progressively worse, photophobia, lethargy, and a fever of 39C. His friend that brought him said that he fell trying to get into the car. He also tells you that his friend has AIDS and that his latest CD4 count was 150. While you were examining him, the patient fell asleep several times. You ordered a chest x-ray and a head CAT scan. Both were normal.

Question 1 - Single Best Answer

What are some common causes of central nervous system infection in AIDS patients?

A) HIV, EEEV, Cryptosporidium

B) Neisseria meningitidis, Streptococcus agalactiae, Streptococcus pneumoniae

C) Cryptosporidium, Cryptococcus, Cyclospora

D) Cryptococcus, HIV, Toxoplasma

E) Treponema pallidum, Toxoplasma, Trichomonas

 

To determine the cause of this patientıs problem you consider doing a lumbar puncture.

Question 2 - Single Best Answer

If you consider a lumbar puncture, which of the following is the best procedure?

A) DO IT

B) wait for 24 hours before doing this invasive procedure to see if the patient improves

C) do a blood culture first

 

You performed a lumbar puncture and found some white cells with a preponderance of lymphocytes, moderately low glucose, (22mg/dl), and moderately high protein (89mg/dl).

Question 3 - Single Best Answer

This is typical of which of the following?

A) no infection

B) untreated bacterial infection

C) viral infection

D) fungal infection

 

 

Question 4 - Single Best Answer

What is the major way that the CSF profile for a bacterial infection differs from that of a fungal infection?

A) the glucose level is higher

B) the protein level is lower

C) there are no WBCıs in a bacterial infection

D) there are more polys in a bacterial infection

 

 

Question 5 - Single Best Answer

The patient had a lower number of WBCıs in the CSF than is usual for a patient with cryptococcal meningitis. What might be the reason for this?

A) he had AIDS

B) he had a worse than normal case of cyrptococcus

C) he had a less serious than normal case of cyrptococcus

 

When you are able to further question the patient, you learn that one of his hobbies is feeding the pigeons in the town square.

Question 6 - Single Best Answer

What disease is most frequently associated with pigeons?

A) histoplasmosis

B) coccidioidomycosis

C) parrot fever

D) sporotrichosis

E) cryptococcosis

 

 

Question 7 - Single Best Answer

To confirm a diagnosis of cryptococcal meningitis, which of the following would you do?

A) look for serum IgG

B) look for serum IgM

C) grow the organism from the spinal fluid

D) india ink stain of the spinal fluid

E) do a latex agglutination test to look for cryptococcal antigen

 

The patientıs CSF was mixed with latex particles coated with rabbit anticryptococcal antibody and also with latex particles coated with non-immune rabbit serum. Agglutination was observed only when anticryptococcal antibody was present, confirming a diagnosis of cryptococcal meningitis.

Question 8 - Single Best Answer

The nonimmune control is done to detect false positive reactions caused by

A) rheumatoid factor

B) anticardiolipin antibody

C) antibody against Proteus

D) antibody against histoplasma

E) antibody against coccidioides

 

 

Question 9 - Single Best Answer

What is the major virulence factor of cryptococcus against which the anticryptococcal antibody is directed?

A) chitin

B) peptidoglycan

C) nuclear membrane

D) capsule

E) pili

 

 

Question 10 - Single Best Answer

What is the portal of entry for cryptococcus?

A) blood via an insect vector

B) skin via an epidermal hydrolase

C) ingestion of undercooked pigeon meat

D) inhalation of mold particles

E) inhalation of yeast spores

 

 

Question 11 - Single Best Answer

How does cryptococcus get from the lung to the brain?

A) retrograde axonal transport

B) hematogenously

C) by invasion of macrophages which are carried to the brain

 

 

Question 12 - Single Best Answer

What is the best treatment for cryptococcal meningitis in an AIDS patient?

A) clindamycin

B) penicillin G

C) amphotericin B

D) 5-flourocytosine

E) combination of amphotericin B and 5-flourocytosine

 

 

Question 13 - Single Best Answer

How is the progress of the therapy followed?

A) improvement of symptoms

B) rise in serum antibodies

C) fall in serum antigen concentration

D) fall in CSF antigen concentration

 

 

Question 14 - Single Best Answer

What is this patientıs prognosis?

A) excellent

B) good

C) poor

D) very poor

 

 

Question 15 - Single Best Answer

Do patients that are not immunosuppressed ever develop cryptococcal meningitis?

A) yes

B) no

 

 

Question 16 - Single Best Answer

What are some less common presentations of cryptococcal disease?

A) lower respiratory tract disease

B) skin nodules

C) bone infections

D) all of the above

 

 

Question 17 - Single Best Answer

What is the geographic distribution of Cryptococcus neoformans, the agent of this manıs disease?

A) it is only found in Africa

B) it is only found in the "New World"

C) it is only found in arid regions of the world

D) it is only found in the Mississippi River and Ohio River valleys

E) it has worldwide distribution

 

 

http://www.medinfo.ufl.edu/year2/mmid/bms5300/cases/index.html