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Hiv mcq
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Hiv mcq

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  • 1. A 40-year-old man with AIDS and a CD4 count of 80/mm3 has a fever and a right lower lobe infiltrate. Which of the following organisms would be considered to be the most likely cause of his pneumonia if recovered from BAL fluid (bronchoalveolar lavage)?a. Cytomegalovirusb. Herpes simplexc. Legionellad. Enterobacter cloaceae. Candida albicans
  • 2. A 40-year-old man with AIDS and a CD4 count of 80/mm3 has a fever and a right lower lobe infiltrate. Which of the following organisms would be considered to be the most likely cause of his pneumonia if recovered from BAL fluid (bronchoalveolar lavage)?a. Cytomegalovirusb. Herpes simplexc. Legionellad. Enterobacter cloaceae. Candida albicans
  • 3. A 32-year-old man with advanced HIV infection presents with cough and low grade fever of two weeks duration. He has a history of PCP, thrush, ITP, and wasting. Recent medications include ddI, d4T, nelfinavir, dapsone, nystatin, and prednisone. Chest x-ray shows a cavity lesion measuring 4 cm in the right lower lobe. A BAL yields Candida albicans, Nocardia asteroides, P. aeruginosa, and CMV. Which of the following antibiotics should be given?a. Ganciclovirb. Amphotericin Bc. Fluconazoled. Ceftazidimee. Trimethoprim-sulfamethoxazole
  • 4. A 32-year-old man with advanced HIV infection presents with cough and low grade fever of two weeks duration. He has a history of PCP, thrush, ITP, and wasting. Recent medications include ddI, d4T, nelfinavir, dapsone, nystatin, and prednisone. Chest x-ray shows a cavity lesion measuring 4 cm in the right lower lobe. A BAL yields Candida albicans, Nocardia asteroides, P. aeruginosa, and CMV. Which of the following antibiotics should be given?a. Ganciclovirb. Amphotericin Bc. Fluconazoled. Ceftazidimee. Trimethoprim-sulfamethoxazole
  • 5. A 25-year-old HIV-infected man presents to your office with severe herpes proctitis. The patient has been treated with acyclovir, 200 mg five times daily for six weeks without improvement in the lesions. On repeat culture of the rectum, herpes simplex virus 2 is again isolated and further testing reveals that this is a thymidine kinase- deficient strain. Which is the preferred treatment option for this condition?a. Foscarnetb. Vidarabinec. Ganciclovird. Valacyclovire. Famciclovir
  • 6. A 25-year-old HIV-infected man presents to your office with severe herpes proctitis. The patient has been treated with acyclovir, 200 mg five times daily for six weeks without improvement in the lesions. On repeat culture of the rectum, herpes simplex virus 2 is again isolated and further testing reveals that this is a thymidine kinase- deficient strain. Which is the preferred treatment option for this condition?a. Foscarnetb. Vidarabinec. Ganciclovird. Valacyclovire. Famciclovir
  • 7. A 43-year-old man with AIDS presents with a four-week history of ataxia, progressive right hand weakness, and tremor. Physical examination confirms his symptoms. His CD4 cell count is 56/mm3, and serum antitoxoplasma IgG antibody titer was negative one year ago. An MRI of the head reveals a solitary 2 x 4 cm lesion in the left cerebellar hemisphere which gives a high signal intensity on T2- weighted images but does not enhance with gadolinium. No mass effect is demonstrated. The most likely diagnosis is:a. Toxoplasmosisb. A fungal abscessc. Primary CNS lymphomad. Progressive multifocal leukoencephalopathy (PML)e. A mycobacterial abscess
  • 8. A 43-year-old man with AIDS presents with a four-week history of ataxia, progressive right hand weakness, and tremor. Physical examination confirms his symptoms. His CD4 cell count is 56/mm3, and serum antitoxoplasma IgG antibody titer was negative one year ago. An MRI of the head reveals a solitary 2 x 4 cm lesion in the left cerebellar hemisphere which gives a high signal intensity on T2- weighted images but does not enhance with gadolinium. No mass effect is demonstrated. The most likely diagnosis is:a. Toxoplasmosisb. A fungal abscessc. Primary CNS lymphomad. Progressive multifocal leukoencephalopathy (PML)e. A mycobacterial abscess
  • 9. A 37-year-old man with advanced HIV infection hospitalized with a fever to 40C, BP 80/60, chills, headache, and diarrhea with 3-5 stools/day for two days. He has a history of PCP x 2, CMV retinitis treated with IV ganciclovir, aphthous ulcers in the mouth, and thrush. Current medications include d4T, ddI, ritonavir, Fortovase, ganciclovir, fluconazole, dapsone, Megace, and vitamins. PE shows only fever and thrush; the Hickman catheter site appears clean and fundoscopic exam shows no new CMV lesions. Lab studies show: WBC 4,200/dL, hematocrit 22%; Chemistry panel-normal except for AST 56 U/L, creatinine 130 mmol/L; Clear chest x-ray; Negative CSF analysis (cryptococcal antigen pending); Stool studies including C. difficile toxin assay are pending. After cultures, treatment should begin immediately with which of the following?a. Trimethoprim-sulfamethoxazoleb. Oral vancomycinc. Ceftazidime plus vancomycind. Amphotericin Be. No antimicrobial treatment pending results of cultures (blood, urine and stool)
  • 10. A 37-year-old man with advanced HIV infection hospitalized with a fever to 40C, BP 80/60, chills, headache, and diarrhea with 3-5 stools/day for two days. He has a history of PCP x 2, CMV retinitis treated with IV ganciclovir, aphthous ulcers in the mouth, and thrush. Current medications include d4T, ddI, ritonavir, Fortovase, ganciclovir, fluconazole, dapsone, Megace, and vitamins. PE shows only fever and thrush; the Hickman catheter site appears clean and fundoscopic exam shows no new CMV lesions. Lab studies show: WBC 4,200/dL, hematocrit 22%; Chemistry panel- normal except for AST 56 U/L, creatinine 130 mmol/L; Clear chest x-ray; Negative CSF analysis (cryptococcal antigen pending); Stool studies including C. difficile toxin assay are pending. After cultures, treatment should begin immediately with which of the following?a. Trimethoprim-sulfamethoxazoleb. Oral vancomycinc. Ceftazidime plus vancomycind. Amphotericin Be. No antimicrobial treatment pending results of cultures (blood, urine and stool)
  • 11. Which of the following drugs accelerates the p450 metabolic pathway?a. Indinavirb. Delavirdinec. Saquinavird. Nevirapinee. Nelfinavir
  • 12. Which of the following drugs accelerates the p450 metabolic pathway?a. Indinavirb. Delavirdinec. Saquinavird. Nevirapinee. Nelfinavir
  • 13. Which of the following shows the best penetration into the central nervous system?a. Nevirapineb. Indinavirc. Nelfinavird. ddIe. ddC
  • 14. Which of the following shows the best penetration into the central nervous system?a. Nevirapineb. Indinavirc. Nelfinavird. ddIe. ddC
  • 15. Which of the following best predicts long-term HIV suppression?a. The nadir of plasma HIV RNA levels following treatmentb. Treatment in relatively early stage disease as indicated by a CD4 count >200/mm3c. A relatively low plasma HIV RNA level at the time antiretroviral therapy is initiatedd. Absence of an AIDS-defining opportunistic infectione. Use of a regimen that contains 2 protease inhibitors
  • 16. Which of the following best predicts long-term HIV
  • 17. Which of the following is least likely to cause peripheral neuropathy?a. Lamivudine (3TC)b. Stavudine (d4T)c. Didanosine (ddI)d. Zalcitabine (ddC)
  • 18. Which of the following is least likely to cause peripheral neuropathy?a. Lamivudine (3TC)b. Stavudine (d4T)c. Didanosine (ddI)d. Zalcitabine (ddC)
  • 19. Which of the following may cause a deceptively high CD4 cell count?a. HTLV II co-infectionb. Splenectomyc. Major surgeryd. Pregnancye. Acute administration of corticosteroids
  • 20. Which of the following may cause a deceptively high CD4 cell count?a. HTLV II co-infectionb. Splenectomyc. Major surgeryd. Pregnancye. Acute administration of corticosteroids
  • 21. Antiretroviral Drugs Approved by FDA for HIVGeneric Name Class Firm FDA Approval Datezidovudine, AZT NRTI Glaxo Wellcome March 87didanosine, ddI NRTI Bristol Myers-Squibb October 91zalcitabine, ddC NRTI Hoffman-La Roche June 92stavudine, d4T NRTI Bristol Myers-Squibb June 94lamivudine, 3TC NRTI Glaxo Wellcome November 95saquinavir, SQV, hgc PI Hoffman-La Roche December 95ritonavir, RTV PI Abbott Laboratories March 96indinavir, IDV PI Merck & Co., Inc. March 96nevirapine, NVP NNRTI Boehringer Ingelheim June 96nelfinavir, NFV PI Agouron Pharmaceuticals March 97delavirdine, DLV NNRTI Pharmacia & Upjohn April 97zidovudine and lamivudine NRTI Glaxo Wellcome September 97saquinavir, SQV, sgc PI Hoffman-La Roche November 97efavirenz, EFV NNRTI DuPont Pharmaceuticals September 98abacavir, ABC NRTI Glaxo Wellcome February 99amprenavir PI Glaxo Wellcome April 99
  • 22. Which of the following vaccines is contraindicated in patients with HIV infection due to the potential to cause infection?a. Tetanusb. Influenzac. Varicellad. Haemophilus influenzae type Be. Hepatitis A virus
  • 23. Which of the following vaccines is contraindicated in patients with HIV infection due to the potential to cause infection?a. Tetanusb. Influenzac. Varicellad. Haemophilus influenzae type Be. Hepatitis A virus
  • 24. Positive serology showing antibody usually indicates which of the following organisms is not present?a. Toxoplasma gondiib. Cytomegalovirusc. Epstein-Barr virusd. Hepatitis B viruse. Varicella-zoster
  • 25. Positive serology showing antibody usually indicates which of the following organisms is not present?a. Toxoplasma gondiib. Cytomegalovirusc. Epstein-Barr virusd. Hepatitis B viruse. Varicella-zoster
  • 26. Which of the following microbes is most likely to cause acerebrospinal fluid showing elevated protein and apolymorphonuclear pleocytosis in late-stage HIV infection?a. Toxoplasma gondiib. Cytomegalovirusc. Treponema pallidumd. JC virus (Progressive multifocal leukoencephalopathy)e. Herpes simplex
  • 27. Which of the following microbes is most likely to cause acerebrospinal fluid showing elevated protein and apolymorphonuclear pleocytosis in late-stage HIV infection?a. Toxoplasma gondiib. Cytomegalovirusc. Treponema pallidumd. JC virus (Progressive multifocal leukoencephalopathy)e. Herpes simplex
  • 28. The most common cause of fever of unknown origin with no focal symptoms in a previously untreated patient with a CD4 count of 10/mm3 is:a. Disseminated M. avium infectionb. Disseminated cytomegalovirusc. Pneumocystis carinii pneumoniad. Toxoplasmosise. Lymphoma
  • 29. The most common cause of fever of unknown origin with no focal symptoms in a previously untreated patient with a CD4 count of 10/mm3 is:a. Disseminated M. avium infectionb. Disseminated cytomegalovirusc. Pneumocystis carinii pneumoniad. Toxoplasmosise. Lymphoma
  • 30. Which of the following fungi is an agent of disseminated infections primarily in southeastern or eastern Asia?a. Penicillium marneffeib. Coccidioides immitisc. Histoplasma capsulatumd. Blastomyces dermatitidise. Paracoccidioides brasiliensis
  • 31. Which of the following fungi is an agent of disseminated infections primarily in southeastern or eastern Asia?a. Penicillium marneffeib. Coccidioides immitisc. Histoplasma capsulatumd. Blastomyces dermatitidise. Paracoccidioides brasiliensis
  • 32. A 45-year-old woman donated blood prior to elective surgery for urinary incontinence. The blood bank reports that the unit is repeatedly reactive in a HIV-1 enzyme immunoassay (EIA), with a negative HIV-1 Western blot. A test done 1 year previously showed the same results. She has no history of blood transfusion or injection drug use, and has been sexually monogamous for ten years with a single partner who has no known HIV risk factors. Your advice is:a. Defer surgery until repeat HIV testing can be done at three monthsb. Advise the patient that she has early HIV infectionc. Perform testing on her sexual partner to determine if he is the source of the infectiond. Test the patients sexual partner for HIVe. Inform the patient that HIV infection is unlikely given the absence of risk factors and the negative Western blot result
  • 33. A 45-year-old woman donated blood prior to elective surgery for urinary incontinence. The blood bank reports that the unit is repeatedly reactive in a HIV-1 enzyme immunoassay (EIA), with a negative HIV-1 Western blot. A test done 1 year previously showed the same results. She has no history of blood transfusion or injection drug use, and has been sexually monogamous for ten years with a single partner who has no known HIV risk factors. Your advice is:a. Defer surgery until repeat HIV testing can be done at three monthsb. Advise the patient that she has early HIV infectionc. Perform testing on her sexual partner to determine if he is the source of the infectiond. Test the patients sexual partner for HIVe. Inform the patient that HIV infection is unlikely given the absence of risk factors and the negative Western blot result
  • 34. All of the following are correct about hairy leukoplakia except:a. It will respond to treatment with acyclovirb. It will respond to treatment with ganciclovirc. It is a rare complication of diseases other than HIV infectiond. It is usually not treatede. Scrapings of it will show pseudomycelia
  • 35. All of the following are correct about hairy leukoplakia except:a. It will respond to treatment with acyclovirb. It will respond to treatment with ganciclovirc. It is a rare complication of diseases other than HIV infectiond. It is usually not treatede. Scrapings of it will show pseudomycelia
  • 36. A 27-year-old intravenous drug abuser is referred to you with positive HIV serology. He is asymptomatic but continues to practice high risk behavior. Past medical history indicates herpes zoster involving the right leg one year ago. Initial evaluation shows the following: WBC 3,400 with 72% PMNs, 5% bands, 15% lymphocytes, 3% monocytes; CD4 count 240/mm3; Chemistry panel normal; Hepatitis serology HBsAg neg and anti-HBs positive; VDRL negative; Chest x-ray negative; PPD negative. Treatment at this time should include which of the following?a. Pneumovaxb. Azithromycin prophylaxisc. PCP prophylaxisd. Hepatitis B vaccinee. Acyclovir
  • 37. A 27-year-old intravenous drug abuser is referred to you with positive HIV serology. He is asymptomatic but continues to practice high risk behavior. Past medical history indicates herpes zoster involving the right leg one year ago. Initial evaluation shows the following: WBC 3,400 with 72% PMNs, 5% bands, 15% lymphocytes, 3% monocytes; CD4 count 240/mm3; Chemistry panel normal; Hepatitis serology HBsAg neg and anti-HBs positive; VDRL negative; Chest x-ray negative; PPD negative. Treatment at this time should include which of the following?a. Pneumovaxb. Azithromycin prophylaxisc. PCP prophylaxisd. Hepatitis B vaccinee. Acyclovir
  • 38. Which of the following is correct about Stavudine (d4T)?a. The major side effect is peripheral neuropathy.b. High level resistance occurs early in treatment when it is given as monotherapy.c. It penetrates the blood-brain barrier better than AZTd. Tablets should be chewed or dissolved in fluids before swallowinge. It commonly causes lactic acidosis
  • 39. Which of the following is correct about Stavudine (d4T)?a. The major side effect is peripheral neuropathy.b. High level resistance occurs early in treatment when it is given as monotherapy.c. It penetrates the blood-brain barrier better than AZTd. Tablets should be chewed or dissolved in fluids before swallowinge. It commonly causes lactic acidosis
  • 40. Which of the following conditions in a person with HIV infection is suggestive of the greatest degree of immunosuppression?a. Peripheral generalized lymphadenopathyb. Thrushc. Pneumonia due to S. pneumoniaed. Cavitary pulmonary tuberculosise. Vaginal candidiasis
  • 41. Which of the following conditions in a person with HIV infection is suggestive of the greatest degree of immunosuppression?a. Peripheral generalized lymphadenopathyb. Thrushc. Pneumonia due to S. pneumoniaed. Cavitary pulmonary tuberculosise. Vaginal candidiasis
  • 42. A HIV-infected patient has cough, fever, and sputum production for 4 days. A chest x-ray shows a left lower lobe infiltrate, the WBC is 4,200/mm3 and a CD4 count is 150/mm3. He takes no medication. The most likely microbial pathogen is:a. S. pneumoniaeb. Mycobacterium tuberculosisc. Rhodococcus equiid. P. cariniie. Cryptococcosis
  • 43. A HIV-infected patient has cough, fever, and sputum production for 4 days. A chest x-ray shows a left lower lobe infiltrate, the WBC is 4,200/mm3 and a CD4 count is 150/mm3. He takes no medication. The most likely microbial pathogen is:a. S. pneumoniaeb. Mycobacterium tuberculosisc. Rhodococcus equiid. P. cariniie. Cryptococcosis
  • 44. A HIV-infected woman has headache, fever, and a seizure. The CD4 count is 56/mm3, WBC is 3,200/mm3, and a MRI shows two ring-enhancing lesions. She takes no medicines other than methadone. The most likely diagnosis is:a. Lymphomab. Toxoplasmosisc. Cryptococcosisd. PMLe. Herpes simplex encephalitis
  • 45. A HIV-infected woman has headache, fever, and a seizure. The CD4 count is 56/mm3, WBC is 3,200/mm3, and a MRI shows two ring-enhancing lesions. She takes no medicines other than methadone. The most likely diagnosis is:a. Lymphomab. Toxoplasmosisc. Cryptococcosisd. PMLe. Herpes simplex encephalitis
  • 46. Which of the following does not have verified benefit in reducing perinatal transmission?a. Intrapartum nevirapineb. Intrapartum AZTc. Intrapartum indinavird. C-sectione. Reduction in viral load during pregnancy
  • 47. Which of the following does not have verified benefit in reducing perinatal transmission?a. Intrapartum nevirapineb. Intrapartum AZTc. Intrapartum indinavird. C-sectione. Reduction in viral load during pregnancy
  • 48. A 40-year-old gay man with HIV infection complains of intermittent crampy abdominal pain and diarrhea for 2 months. The major concern is 1-3 loose stools daily accompanied by bloating. He took AZT, ddI, and indinavir, but discontinued this when he noted the abdominal symptoms. Nevertheless, there was no improvement. He has been well otherwise and afebrile. He has a CD4 count of 350/mm3. The most likely diagnosis is:a. Salmonellosisb. C. difficile colitisc. Microsporidiad. Irritable bowel syndromee. Kaposis sarcoma of the gut
  • 49. A 40-year-old gay man with HIV infection complains of intermittent crampy abdominal pain and diarrhea for 2 months. The major concern is 1-3 loose stools daily accompanied by bloating. He took AZT, ddI, and indinavir, but discontinued this when he noted the abdominal symptoms. Nevertheless, there was no improvement. He has been well otherwise and afebrile. He has a CD4 count of 350/mm3. The most likely diagnosis is:a. Salmonellosisb. C. difficile colitisc. Microsporidiad. Irritable bowel syndromee. Kaposis sarcoma of the gut
  • 50. Which of the following drugs has been associated with serious hypersensitivity reactions characterized by fever, GI distress, and rash?a. Efavirenzb. Hydroxyureac. Abacavird. Saquinavire. Nelfinavir
  • 51. Which of the following drugs has been associated with serious hypersensitivity reactions characterized by fever, GI distress, and rash?a. Efavirenzb. Hydroxyureac. Abacavird. Saquinavire. Nelfinavir
  • 52. The opportunistic organism most likely to infect the adrenal gland in patients with advanced HIV infection is:a. M. aviumb. Histoplasma capsulatumc. Candida albicansd. CMVe. Cryptococcus neoformans
  • 53. The opportunistic organism most likely to infect the adrenal gland in patients with advanced HIV infection is:a. M. aviumb. Histoplasma capsulatumc. Candida albicansd. CMVe. Cryptococcus neoformans
  • 54. Which of the following is most likely to show no white blood cells in cerebrospinal fluid?a. Toxoplasma encephalitisb. CNS lymphomac. Progressive multifocal leukoencephalopathyd. Neurosyphilise. CMV encephalitis
  • 55. Which of the following is most likely to show no white blood cells in cerebrospinal fluid?a. Toxoplasma encephalitisb. CNS lymphomac. Progressive multifocal leukoencephalopathyd. Neurosyphilise. CMV encephalitis
  • 56. A patient with HIV infection is receiving no medications and is seen for routine follow-up. At the previous visit 6 months ago, the CD4 count was 860/mm3 and the CD4 percentage was 46%. The viral burden at that time was 562 copies/ml. At this visit the CD4 count is 620/mm3 and the CD4 percentage is 40%. The viral burden is undetectable (less than 400 copies/ml). Which of the following would be most appropriate?a. Repeat the CD4-cell count in the same labb. Repeat the CD4-cell count, but use a different labc. Request a complete T-subset analysisd. Obtain additional studies for HIV staging including B2 microglobulin and neopterine. Do nothing and see the patient in 3 months
  • 57. A patient with HIV infection is receiving no medications and is seen for routine follow-up. At the previous visit 6 months ago, the CD4 count was 860/mm3 and the CD4 percentage was 46%. The viral burden at that time was 562 copies/ml. At this visit the CD4 count is 620/mm3 and the CD4 percentage is 40%. The viral burden is undetectable (less than 400 copies/ml). Which of the following would be most appropriate?a. Repeat the CD4-cell count in the same labb. Repeat the CD4-cell count, but use a different labc. Request a complete T-subset analysisd. Obtain additional studies for HIV staging including B2 microglobulin and neopterine. Do nothing and see the patient in 3 months
  • 58. A 25-year-old man with advanced HIV infection is hospitalized with fever and diarrhea of 2-3 weeks duration. He has been treated with ddI, ritonavir, saquinavir, and trimethoprim-sulfamethoxazole. Exam shows thrush, wasting, and KS lesions on the face and arms. Admission laboratory studies show: Hematocrit of 28%, WBC 3,100/mm3; CD4 count of 2/mm3; ALT of 56 IU/L, alkaline phosphatase of 211 IU/L, amylase of 53 IU/L, a potassium of 3.1 MEQ/L, and an albumin of 2.3 gm/dL; Chest x-ray is negative; Blood culture at 48 hours yields S. epidermidis; Stool C. difficile toxin assay is negative, stool culture is negative, Stool O&P exam shows Blastocystis hominis.Treatment directed against which organism is most likely to produce defervescence?a. S. epidermidisb. Microsporidiac. Blastocystis hominisd. Cryptosporidiae. M. avium complex
  • 59. A 25-year-old man with advanced HIV infection is hospitalized with fever and diarrhea of 2-3 weeks duration. He has been treated with ddI, ritonavir, saquinavir, and trimethoprim-sulfamethoxazole. Exam shows thrush, wasting, and KS lesions on the face and arms. Admission laboratory studies show: Hematocrit of 28%, WBC 3,100/mm3; CD4 count of 2/mm3; ALT of 56 IU/L, alkaline phosphatase of 211 IU/L, amylase of 53 IU/L, a potassium of 3.1 MEQ/L, and an albumin of 2.3 gm/dL; Chest x-ray is negative; Blood culture at 48 hours yields S. epidermidis; Stool C. difficile toxin assay is negative, stool culture is negative, Stool O&P exam shows Blastocystis hominis.Treatment directed against which organism is most likely to produce defervescence?a. S. epidermidisb. Microsporidiac. Blastocystis hominisd. Cryptosporidiae. M. avium complex
  • 60. A 27-year-old gay man has negative HIV serology but continues to practice high risk behavior. He requests assurance that he does not have HIV infection. The most sensitive blood test to provide this assurance is:a. p24 antigenb. Routine serologic testc. HIV DNA assayd. HIV RNA levele. HIV culture
  • 61. A 27-year-old gay man has negative HIV serology but continues to practice high risk behavior. He requests assurance that he does not have HIV infection. The most sensitive blood test to provide this assurance is:a. p24 antigenb. Routine serologic testc. HIV DNA assayd. HIV RNA levele. HIV culture
  • 62. The most common side-effect of nelfinavir is:a. Epigastric painb. Diarrheac. Headached. Nephrolithiasise. Neuropathy
  • 63. The most common side-effect of nelfinavir is:a. Epigastric painb. Diarrheac. Headached. Nephrolithiasise. Neuropathy
  • 64. A 32-year-old man with AIDS consults for fever, a rash of 3-5 days duration andpainful feet of two weeks duration. He had PCP eight months previously and hassubsequently received AZT, ddI, saquinavir, ketoconazole (200 mg/day),trimethoprim-sulfamethoxazole (1 DS/day), and vitamin C (1 gm daily). He wasseen for a routine visit three weeks ago and was asymptomatic with a negativephysical exam and the following laboratory tests:WBC 2,100/mm3 (75% PMNs, 4% bands, 13% lymphs, 8% monocytes);Hematocrit 32%, platelet count of 80,000/mm3;AST 38 IU/L.Physical exam now shows a maculopapular rash, a supple neck and fever of 38.8C.Laboratory studies now show:WBC 1,200 (45% PMSs, 7% bands, 32% lymphocytes, 16% monocytes);Hematocrit 26%;Platelet count 62,000/mm3,AST 462 IU/L, alkaline phosphatase of 210 IU/L.Which of the following drugs is an unlikely cause of an adverse drug reaction in thispatient?a. AZTb. Trimethoprim-sulfamethoxazolec. Ketoconazoled. ddIe. Vitamin C
  • 65. A 32-year-old man with AIDS consults for fever, a rash of 3-5 days duration andpainful feet of two weeks duration. He had PCP eight months previously and hassubsequently received AZT, ddI, saquinavir, ketoconazole (200 mg/day),trimethoprim-sulfamethoxazole (1 DS/day), and vitamin C (1 gm daily). He wasseen for a routine visit three weeks ago and was asymptomatic with a negativephysical exam and the following laboratory tests:WBC 2,100/mm3 (75% PMNs, 4% bands, 13% lymphs, 8% monocytes);Hematocrit 32%, platelet count of 80,000/mm3;AST 38 IU/L.Physical exam now shows a maculopapular rash, a supple neck and fever of 38.8C.Laboratory studies now show:WBC 1,200 (45% PMSs, 7% bands, 32% lymphocytes, 16% monocytes);Hematocrit 26%;Platelet count 62,000/mm3,AST 462 IU/L, alkaline phosphatase of 210 IU/L.Which of the following drugs is an unlikely cause of an adverse drug reaction in thispatient?a. AZTb. Trimethoprim-sulfamethoxazolec. Ketoconazoled. ddIe. Vitamin C
  • 66. Albendazole is effective therapy for most patients infectedby:a. Toxoplasma gondiib. Enterocytozoon bienusic. Septata intestinalisd. Cryptosporidiae. Cyclospora
  • 67. Albendazole is effective therapy for most patients infectedby:a. Toxoplasma gondiib. Enterocytozoon bienusic. Septata intestinalisd. Cryptosporidiae. Cyclospora
  • 68. The average efficiency of HIV transmission with a single episode of unprotected receptive vaginal intercourse with an untreated HIV infected source is approximately?a. 30%b. 3%c. 0.3%d. 0.03%e. 0.003%
  • 69. The average efficiency of HIV transmission with a single episode of unprotected receptive vaginal intercourse with an untreated HIV infected source is approximately?a. 30%b. 3%c. 0.3%d. 0.03%e. 0.003%
  • 70. A 30-year old woman with HIV infection and a CD4 count of 180/mm3 has a platelet count of 40,000/mm3. She reports mild gum bleeding while brushing teeth, but denies other forms of bleeding and has not noted bruising. Her platelet count 3 months ago was 65,000/mm3. Medications do not appear to be the cause of her thrombocytopenia. What treatment is appropriate at this time?a. IVIGb. Prednisonec. Splenic irradiationd. Danazole. No treatment
  • 71. A 30-year old woman with HIV infection and a CD4 count of 180/mm3 has a platelet count of 40,000/mm3. She reports mild gum bleeding while brushing teeth, but denies other forms of bleeding and has not noted bruising. Her platelet count 3 months ago was 65,000/mm3. Medications do not appear to be the cause of her thrombocytopenia. What treatment is appropriate at this time?a. IVIGb. Prednisonec. Splenic irradiationd. Danazole. No treatment
  • 72. Fecal leukocytes are most likely with diarrhea due to:a. Mycobacteriumb. Septata intestinalisc. Cryptosporidiumd. Isosporae. Cytomegalovirus
  • 73. Fecal leukocytes are most likely with diarrhea due to:a. Mycobacteriumb. Septata intestinalisc. Cryptosporidiumd. Isosporae. Cytomegalovirus
  • 74. A 28-year old gay man has progressive dyspnea andhypoxemia over 2-3 months. He is afebrile and has a CD4count of 26/mm3. Chest x-ray shows alveolar infiltratesbilaterally, hilar adenopathy and a pleural effusion.Bronchscopy with BAL and a transbronchial biopsy isnegative. A gallium scan negative. The most likely cause is:a. Histoplasmosisb. Coccidiodomycosisc. Lymphocytic interstitial pneumoniad. Lymphomae. Kaposi sarcoma
  • 75. A 28-year old gay man has progressive dyspnea andhypoxemia over 2-3 months. He is afebrile and has a CD4count of 26/mm3. Chest x-ray shows alveolar infiltratesbilaterally, hilar adenopathy and a pleural effusion.Bronchscopy with BAL and a transbronchial biopsy isnegative. A gallium scan negative. The most likely cause is:a. Histoplasmosisb. Coccidiodomycosisc. Lymphocytic interstitial pneumoniad. Lymphomae. Kaposi sarcoma
  • 76. Which of the following drugs is recommended for AIDS
  • 77. Which of the following drugs is recommended for AIDS patients with bacillary angiomatosis?a. Penicillinb. Ciprofloxacinc. Erythromycind. Cephalosporine. Vancomycin
  • 78. Which of the following drugs is the most potent inhibitor of the hepatic p450 metabolic pathway?a. Ritonavirb. Saquinavirc. Rifampind. Nevirapinee. Abacavir
  • 79. Which of the following drugs is the most potent inhibitor of the hepatic p450 metabolic pathway?a. Ritonavirb. Saquinavirc. Rifampind. Nevirapinee. Abacavir
  • 80. Most patients in late-stage HIV infection develop toxoplasmosis from which of the following?a. New infection following exposure to cat stoolb. New infection following exposure to undercooked meatc. New infection from exposure to a patient with toxoplasmosisd. New infection from contaminated watere. Activation of latent infection
  • 81. Most patients in late-stage HIV infection develop toxoplasmosis from which of the following?a. New infection following exposure to cat stoolb. New infection following exposure to undercooked meatc. New infection from exposure to a patient with toxoplasmosisd. New infection from contaminated watere. Activation of latent infection
  • 82. Which of the following drugs have been associated with hypertriglyceridemia?a. Ritonavirb. Hydroxyureac. Delavirdined. Abacavire. Stavudine (d4T)
  • 83. Which of the following drugs have been associated with hypertriglyceridemia?a. Ritonavirb. Hydroxyureac. Delavirdined. Abacavire. Stavudine (d4T)
  • 84. Which of the following is not detected with AFB stain ofstool in patients with diarrhea?a. Cryptosporidia parvumb. Cyclospora cayetanensisc. Isospora bellid. Microsporidiae. Septata intestinalis
  • 85. Which of the following is not detected with AFB stain ofstool in patients with diarrhea?a. Cryptosporidia parvumb. Cyclospora cayetanensisc. Isospora bellid. Microsporidiae. Septata intestinalis
  • 86. A 40-year-old man with HIV infection complains of headache, fever, and blurred vision. He takes AZT, 3TC, nelfinavir, dapsone, and INH. Exam shows thrush and perirectal vesicles. A CD4 count is 86/mm3 and a head MRI is negative. The most likely diagnosis of his CNS infection is:a. T. pallidumb. Toxoplasma gondiic. Cryptococcusd. Progressive multifocal leukoencephalopathye. H. simplex
  • 87. A 40-year-old man with HIV infection complains of headache, fever, and blurred vision. He takes AZT, 3TC, nelfinavir, dapsone, and INH. Exam shows thrush and perirectal vesicles. A CD4 count is 86/mm3 and a head MRI is negative. The most likely diagnosis of his CNS infection is:a. T. pallidumb. Toxoplasma gondiic. Cryptococcusd. Progressive multifocal leukoencephalopathye. H. simplex
  • 88. A 32-year-old woman with HIV infection complains of intermittent diarrhea without fever for 30 days and fatigue. She takes d4T, 3TC, nevirapine, dapsone, and fluconazole. A CD4 count is 70/mm3. The single most likely diagnosis is infection due to:a. Giardiab. E. histolyticac. C. difficiled. Salmonellae. Cryptosporidia
  • 89. A 32-year-old woman with HIV infection complains of in te r m itt e nt di ar r h ea w it h o

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