A 26 year old male presents to the Emergency Room with complaints of generalized headaches, nausea, vomiting, and fever. The patient states that he seems to smell odors which his wife ca not smell and his wife has noted increased irritability. Several hours prior to coming to the emergency room, he had what the wife thought was a "seizure". Physical exam reveals a temperature of 38.6, respiratory rate of 22/minute, a heart rate of 110/minute and blood pressure of 110/70. Neurological exam reveals intact cranial nerves, no papilledema, bilateral 1+ deep tendon reflexes and normal bilateral tone and strength in extremities. The patient does seem confused and disoriented slightly. The patient exhibits some speech problems by mispronouncing simple words. Laboratory values reveal normal CBC, glucose, calcium, electrolytes, urinalysis, and thyroid function studies except for a mildly increased serum TSH. A lumbar puncture was preformed revealing a total protein of 110mg/dl(N=15-45mg/dl), glucose 60mg/dl(N=50-75mg/dl), cell count – 460/ul(N=0-5) with predominantly lymphocytes (90%), and gram stain revealed no organisms.

You order a CT-scan represented below.

The most likely diagnosis in this patient is:

A. Herpes encephalitis

B. Meningitis secondary to Listeria monocytogenes

C. Pick's disease

D. HIV-1 meningoencephalitis

E. Progressive multifocal leukoencephalopathy (JC virus)

2.The percentage of patients with this diagnosis who have a previous history of "fever blisters" is:

A. 0%

B. 10%

C. 50%

D. 90%

E. 100%

3. The following statements is/are true regarding this patient's diagnosis:

A. The brain typically contains Negri bodies in hippocampal neurons and cerebellar Purkinje cells.

B. Microglial nodules containing multinucleated giant cells may be found.

C. Nuclei of oligodendrocytes typically have glassy inclusions.

D. Usually involves the medial and inferior aspects of the temporal lobe and orbital aspects of the frontal lobes.

E. All of the above.

4. The pathogenesis of this process:

A. Usually develops as an opportunistic infection in immunosuppressed individuals

B. Involves sensory nerves, transported to ganglia where it remains latent until unknown factors induce activation

C. It is caused by a slow virus and can be transmitted by corneal transplants, EEG electrodes and cadaveric growth hormone

D. Enters via the gastrointestinal tract and spreads to CNS and invades the brain stem

E. It infects oligodendrocytes causing demyelination

5. The following statement(s) is/are true regarding CNS viral infections:

A. Patients with HIV-1 meningoencephalitis usually present with memory loss, mood disturbances, depression, ataxia, and sometimes bladder incontinence.

B. Patients with arboviral encephalitis present with seizures, confusion, stupor and may have focal neurologic findings as ocular palsies and reflex assymetry.

C. Olfactory hallucinations are commonly seen in herpetic encephalitis.

D. Negri bodies within cerebellar Purkinje cells are pathognomonic of rabies.

E. All of the above.

6. The following statements is/are true regarding CNS viral infections:

A. Rubeola virus may cause subacute sclerosing panencephalitis years after an acute childhood infection.

B. Viral encephalitis exhibits parenchymal and perivascular infiltrates of lymphocytes and plasma cells

C. The most common CNS viral infection in patients with AIDS is CMV

D. Patients with poliomyelitis develop 25-30 years later, a syndrome of progressive weakness, pain, and decreased muscle mass known as the postpolio syndrome

E. All of the above.