Organic mental disorders: herpes simplex encephalitis: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Organic mental disorders: herpes simplex encephalitis

Sample item

A 40-year-old woman has 3 days of fever, headache and sudden personality change, with olfactory hallucinations and a focal seizure. CSF shows lymphocytes and red cells, and MRI shows temporal lobe oedema. What is the next best step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Start intravenous acyclovir immediately

Herpes simplex encephalitis preferentially damages the temporal and orbitofrontal lobes, producing fever, behavioural change, seizures and olfactory or gustatory hallucinations. Untreated mortality is high, so intravenous acyclovir is started empirically without waiting for the CSF PCR result.

Option by option

  • A. Give antipsychotics for the behavioural change

    Antipsychotics treat symptoms without addressing the cause and may lower the seizure threshold.

  • B. Start intravenous acyclovir immediately (correct)

    Correct. Prompt intravenous acyclovir reduces mortality and neurological damage.

  • C. Wait for the PCR result before treatment

    Delaying treatment while awaiting PCR risks irreversible brain damage.

  • D. Prescribe oral valaciclovir

    Oral valaciclovir does not achieve adequate CNS levels for this severe infection.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Start intravenous acyclovir immediately. Herpes simplex encephalitis preferentially damages the temporal and orbitofrontal lobes, producing fever, behavioural change, seizures and olfactory or gustatory hallucinations.

Why is "Give antipsychotics for the behavioural change" not the answer?

Antipsychotics treat symptoms without addressing the cause and may lower the seizure threshold.

Why is "Wait for the PCR result before treatment" not the answer?

Delaying treatment while awaiting PCR risks irreversible brain damage.

Why is "Prescribe oral valaciclovir" not the answer?

Oral valaciclovir does not achieve adequate CNS levels for this severe infection.

What concept does this question test?

It tests Organic mental disorders: herpes simplex encephalitis in Psychiatry. Untreated mortality is high, so intravenous acyclovir is started empirically without waiting for the CSF PCR result.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Organic mental disorders: herpes simplex encephalitis?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.