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
B) it is only found in the
"
C) it is only found in arid regions
of the world
D) it is only found in the
E) it has worldwide distribution
http://www.medinfo.ufl.edu/year2/mmid/bms5300/cases/index.html