Meningitis and Nervous System Infections Practice Questions

25 multiple-choice questions on Meningitis and nervous system infections for paramedic and EMT students, from Chapter 27 (Infectious Diseases). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. An 82-year-old nursing home resident has a fever and new confusion but no neck stiffness. Regarding meningitis, you should know that:

   1. A. A soft, supple neck rules out meningitis
   2. B. Older adults may lack classic signs
   3. C. Meningitis spares adults over the age of 80
   4. D. Confusion excludes infection
   Show answer

   Answer: B. Older adults may lack classic signs

   Older adults with bacterial meningitis often present with confusion and fever, and neck stiffness can be absent or confused with arthritis. Treat fever with altered mental status as a possible serious infection and transport promptly.

2. Most cases of viral meningitis in the US are caused by:

   1. A. Enteroviruses
   2. B. Rhinoviruses
   3. C. Hepatitis A virus
   4. D. Influenza B
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   Answer: A. Enteroviruses

   Enteroviruses, spread by the fecal-oral and respiratory routes and peaking in summer and fall, cause most viral meningitis. It is usually milder than bacterial meningitis, but the two cannot be told apart in the field.

3. A positive Kernig sign is:

   1. A. Neck flexion causing hip and knee flexion
   2. B. A rash that does not blanch with pressure
   3. C. Pain on knee extension with hip flexed
   4. D. Pain when pressing gently on the eyeball
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   Answer: C. Pain on knee extension with hip flexed

   Kernig and Brudzinski signs indicate meningeal irritation.

4. A pregnant woman who often eats deli meats and soft cheeses has fever, headache, and a stiff neck. A specific organism to consider is:

   1. A. Shigella
   2. B. Salmonella
   3. C. Listeria
   4. D. E. coli O157
   Show answer

   Answer: C. Listeria

   Listeria, found in deli meats, unpasteurized soft cheeses, and some produce, causes meningitis and bloodstream infection mainly in pregnant women, newborns, older adults, and the immunocompromised. It can cause miscarriage and needs specific antibiotics. Shigella, Salmonella, and E. coli O157 cause foodborne diarrhea rather than meningitis.

5. A 2-year-old with a fever had a brief generalized seizure and is now alert and playful. Which finding would most raise concern for meningitis?

   1. A. A temperature of 39 °C (102.2 °F) at the scene
   2. B. A stiff neck or persistent lethargy
   3. C. A generalized seizure lasting under 5 minutes
   4. D. A sibling at home who had a recent cold
   Show answer

   Answer: B. A stiff neck or persistent lethargy

   A simple febrile seizure is brief, generalized, and followed by a quick return to normal. A stiff neck, persistent drowsiness, bulging fontanelle, petechiae, or a prolonged or focal seizure suggests meningitis or another serious cause. A high fever by itself is common in febrile seizures.

6. A healthy, vaccinated pet dog bit a child, and the dog's owner can be found. Regarding rabies, the usual approach is to:

   1. A. Euthanize the dog now
   2. B. Start the vaccine series if a fever occurs
   3. C. Ignore it, since pets cannot carry rabies
   4. D. Observe the dog for 10 days
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   Answer: D. Observe the dog for 10 days

   A healthy dog, cat, or ferret that bites can be confined and observed for 10 days. If it stays healthy, it could not have transmitted rabies, and PEP is not needed. Clean the wound well and report the bite.

7. A 4-year-old has rapidly worsening weakness that started in the legs and now involves the arms, with no fever. A parent found a tick in her scalp. You should:

   1. A. Remove the tick and transport
   2. B. Leave the tick for the hospital
   3. C. Give aspirin for her weakness
   4. D. Wait to see if a rash appears
   Show answer

   Answer: A. Remove the tick and transport

   Tick paralysis is caused by a toxin in tick saliva and produces an ascending paralysis that can reach the breathing muscles. Removing the tick usually leads to recovery within hours to days. Monitor breathing closely.

8. Viral meningitis compared with bacterial meningitis is usually:

   1. A. Milder and self-limited
   2. B. Rapidly fatal
   3. C. Treated with antibiotics
   4. D. Associated with purpura
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   Answer: A. Milder and self-limited

   Bacterial meningitis is a medical emergency.

9. A man who injects black tar heroin has double vision, drooping eyelids, slurred speech, and trouble swallowing. You should suspect:

   1. A. Opioid overdose
   2. B. Wound botulism
   3. C. Bell palsy
   4. D. Tetanus infection
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   Answer: B. Wound botulism

   Spores in black tar heroin can grow in injection sites and release botulinum toxin, causing descending paralysis that starts with the eyes and throat. Monitor breathing closely and report it; antitoxin comes from the hospital and health department.

10. A traveler who returned from West Africa 2 weeks ago has a high fever, confusion, and a seizure. A life-threatening cause to consider is:

    1. A. Influenza
    2. B. Delayed heat stroke
    3. C. Cerebral malaria
    4. D. Febrile seizure disorder
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    Answer: C. Cerebral malaria

    Falciparum malaria can cause cerebral malaria with confusion, seizures, and coma, and it can be fatal within days. Always ask about travel in a febrile patient, and tell the hospital, so that testing and treatment begin quickly. Heat stroke does not appear 2 weeks after the heat exposure, febrile seizures are a disorder of young children, and influenza rarely causes seizures in adults.

11. The most common cause of viral encephalitis in the US is:

    1. A. Measles virus
    2. B. Seasonal influenza virus
    3. C. Rhinovirus
    4. D. Herpes simplex virus
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    Answer: D. Herpes simplex virus

    HSV encephalitis is treated with acyclovir.

12. A teenager has severe headache, fever, and confusion several days after swimming in a warm freshwater lake in July. A rare but deadly cause is:

    1. A. Giardia swallowed in the water
    2. B. A bacterial ear infection
    3. C. An amoeba that entered the nose
    4. D. Swimmer's itch parasites in skin
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    Answer: C. An amoeba that entered the nose

    Naegleria fowleri lives in warm fresh water and enters the brain through the nose, causing a rapidly fatal meningoencephalitis. It is not spread by drinking water or from person to person. Mention the freshwater exposure to the hospital. Giardia causes diarrhea, not brain infection, and swimmer's itch is an itchy skin rash.

13. Rabies is transmitted through:

    1. A. Blood transfusion only
    2. B. Saliva of an infected animal
    3. C. Contaminated drinking water
    4. D. Airborne respiratory droplets
    Show answer

    Answer: B. Saliva of an infected animal

    Bats, raccoons, skunks, and foxes are common reservoirs in the US.

14. Once rabies symptoms appear, it is:

    1. A. Easily treated
    2. B. Self-limited
    3. C. Cured by antibiotics
    4. D. Almost always fatal
    Show answer

    Answer: D. Almost always fatal

    Post-exposure prophylaxis must be started before symptoms appear.

15. Rabies post-exposure prophylaxis includes:

    1. A. Immune globulin and vaccine
    2. B. Immune globulin alone
    3. C. Antiviral pills for 10 days
    4. D. A tetanus shot and antibiotics
    Show answer

    Answer: A. Immune globulin and vaccine

    Wound cleansing with soap and water is also critical. An unvaccinated person needs both immune globulin and the vaccine series. No antiviral pill prevents rabies, and tetanus shots and antibiotics do not protect against the virus.

16. A person who wakes to find a bat in the bedroom should:

    1. A. Ignore it if no bite is seen
    2. B. Be evaluated for rabies PEP
    3. C. Take antibiotics
    4. D. Wait for symptoms
    Show answer

    Answer: B. Be evaluated for rabies PEP

    Bat bites can be tiny and go unnoticed.

17. A patient on chemotherapy has a widespread blistering rash, diagnosed as disseminated shingles. Which precautions apply?

    1. A. Standard precautions with the rash covered
    2. B. Droplet precautions
    3. C. Contact precautions with gown and gloves
    4. D. Airborne and contact precautions
    Show answer

    Answer: D. Airborne and contact precautions

    Localized shingles in a healthy person needs standard precautions with the rash covered, but disseminated zoster, or any zoster in an immunocompromised patient, can spread through the air like chickenpox. Use an N95, gown, and gloves.

18. A patient with suspected rabies drools on a paramedic's intact forearm. Regarding rabies PEP, the paramedic:

    1. A. Needs the full rabies PEP series today
    2. B. Needs a dose of rabies immune globulin
    3. C. Does not need it; wash the skin
    4. D. Needs quarantine
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    Answer: C. Does not need it; wash the skin

    Rabies spreads when saliva or nervous tissue enters a wound or touches mucous membranes. Saliva on intact skin is not an exposure, so washing is enough. Report it; PEP is needed if saliva reached broken skin, eyes, nose, or mouth.

19. A 3-month-old has had constipation for several days and is now feeding poorly, with a weak cry and floppy limbs. You should suspect:

    1. A. Infant botulism
    2. B. Normal colic
    3. C. Simple teething
    4. D. Viral croup
    Show answer

    Answer: A. Infant botulism

    Infant botulism often begins with constipation, then weak sucking, a weak cry, drooping eyelids, and generalized floppiness as the toxin spreads. Breathing can fail, so monitor ventilation closely and transport.

20. Reye syndrome causes:

    1. A. Kidney stones and flank pain
    2. B. Severe hemolytic anemia
    3. C. Liver failure, brain swelling
    4. D. Bleeding into the joints
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    Answer: C. Liver failure, brain swelling

    It occurs in children given aspirin during viral illnesses.

21. A brain abscess may present with:

    1. A. Headache, fever, and focal deficits
    2. B. Sudden worst headache, no fever
    3. C. Weakness that ascends from the legs up
    4. D. Joint pain and swelling
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    Answer: A. Headache, fever, and focal deficits

    It may develop after sinus, ear, or dental infections. A sudden worst headache without fever suggests subarachnoid hemorrhage, and weakness that ascends from the legs suggests Guillain-Barre syndrome.

22. Neurosyphilis is a late complication of:

    1. A. Untreated gonorrhea
    2. B. Untreated chlamydia
    3. C. Herpes simplex
    4. D. Untreated syphilis
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    Answer: D. Untreated syphilis

    It can cause dementia, psychosis, and gait problems.

23. For routine EMS care of a patient with Creutzfeldt-Jakob disease, infection control requires:

    1. A. Airborne isolation
    2. B. Standard precautions
    3. C. Droplet precautions
    4. D. A full hazmat suit with respirator
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    Answer: B. Standard precautions

    CJD is not spread through the air or by casual contact. Routine care needs only standard precautions; special sterilization matters only for instruments that contact brain, spinal cord, or eye tissue.

24. An adult with meningitis symptoms should receive which prehospital care?

    1. A. Oral antibiotics before transport
    2. B. Ice-water immersion
    3. C. Delayed transport until fever falls
    4. D. Supportive care, rapid transport
    Show answer

    Answer: D. Supportive care, rapid transport

    Manage the airway, treat seizures and shock, and transport promptly. Ice-water immersion is for heat stroke, not infection, and waiting for the fever to fall delays the antibiotics that the hospital must give quickly.

25. Which patient is at highest risk of meningococcal disease?

    1. A. College students in dormitories
    2. B. Office workers in large cities
    3. C. Retired adults living at home
    4. D. Farmers in rural communities
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    Answer: A. College students in dormitories

    Crowded living conditions increase spread. A vaccine is recommended for adolescents.