A 45-year-old woman's blood donation tested repeatedly reactive for HIV-1 on an enzyme immunoassay but had a negative Western blot. She has no risk factors for HIV and had a similar test result 1 year ago. The best advice is to inform her that HIV infection is unlikely given her negative Western blot and lack of risk factors.

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. Cytomegalovirus
b. Herpes simplex
c. Legionella
d. Enterobacter cloacea
e. 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. Cytomegalovirus
b. Herpes simplex
c. Legionella
d. Enterobacter cloacea
e. 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. Ganciclovir
b. Amphotericin B
c. Fluconazole
d. Ceftazidime
e. 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. Ganciclovir
b. Amphotericin B
c. Fluconazole
d. Ceftazidime
e. 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. Foscarnet
b. Vidarabine
c. Ganciclovir
d. Valacyclovir
e. 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. Foscarnet
b. Vidarabine
c. Ganciclovir
d. Valacyclovir
e. 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. Toxoplasmosis
b. A fungal abscess
c. Primary CNS lymphoma
d. 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. Toxoplasmosis
b. A fungal abscess
c. Primary CNS lymphoma
d. 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-sulfamethoxazole
b. Oral vancomycin
c. Ceftazidime plus vancomycin
d. Amphotericin B
e. 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-sulfamethoxazole
b. Oral vancomycin
c. Ceftazidime plus vancomycin
d. Amphotericin B
e. No antimicrobial treatment pending results of cultures (blood, urine
and stool)

11. Which of the following drugs accelerates the p450
metabolic pathway?
a. Indinavir
b. Delavirdine
c. Saquinavir
d. Nevirapine
e. Nelfinavir

12. Which of the following drugs accelerates the p450
metabolic pathway?
a. Indinavir
b. Delavirdine
c. Saquinavir
d. Nevirapine
e. Nelfinavir

13. Which of the following shows the best penetration into
the central nervous system?
a. Nevirapine
b. Indinavir
c. Nelfinavir
d. ddI
e. ddC

14. Which of the following shows the best penetration into
the central nervous system?
a. Nevirapine
b. Indinavir
c. Nelfinavir
d. ddI
e. ddC

15. Which of the following best predicts long-term HIV
suppression?
a. The nadir of plasma HIV RNA levels following treatment
b. Treatment in relatively early stage disease as indicated
by a CD4 count >200/mm3
c. A relatively low plasma HIV RNA level at the time
antiretroviral therapy is initiated
d. Absence of an AIDS-defining opportunistic infection
e. 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-infection
b. Splenectomy
c. Major surgery
d. Pregnancy
e. Acute administration of corticosteroids

20. Which of the following may cause a deceptively high CD4
cell count?
a. HTLV II co-infection
b. Splenectomy
c. Major surgery
d. Pregnancy
e. Acute administration of corticosteroids

21. Antiretroviral Drugs Approved by FDA for HIV
Generic Name Class Firm FDA Approval Date
zidovudine, AZT NRTI Glaxo Wellcome March 87
didanosine, ddI NRTI Bristol Myers-Squibb October 91
zalcitabine, ddC NRTI Hoffman-La Roche June 92
stavudine, d4T NRTI Bristol Myers-Squibb June 94
lamivudine, 3TC NRTI Glaxo Wellcome November 95
saquinavir, SQV, hgc PI Hoffman-La Roche December 95
ritonavir, RTV PI Abbott Laboratories March 96
indinavir, IDV PI Merck & Co., Inc. March 96
nevirapine, NVP NNRTI Boehringer Ingelheim June 96
nelfinavir, NFV PI Agouron Pharmaceuticals March 97
delavirdine, DLV NNRTI Pharmacia & Upjohn April 97
zidovudine and lamivudine NRTI Glaxo Wellcome September 97
saquinavir, SQV, sgc PI Hoffman-La Roche November 97
efavirenz, EFV NNRTI DuPont Pharmaceuticals September 98
abacavir, ABC NRTI Glaxo Wellcome February 99
amprenavir 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. Tetanus
b. Influenza
c. Varicella
d. Haemophilus influenzae type B
e. Hepatitis A virus

23. Which of the following vaccines is contraindicated in
patients with HIV infection due to the potential to cause
infection?
a. Tetanus
b. Influenza
c. Varicella
d. Haemophilus influenzae type B
e. Hepatitis A virus

24. Positive serology showing antibody usually indicates which
of the following organisms is not present?
a. Toxoplasma gondii
b. Cytomegalovirus
c. Epstein-Barr virus
d. Hepatitis B virus
e. Varicella-zoster

25. Positive serology showing antibody usually indicates which
of the following organisms is not present?
a. Toxoplasma gondii
b. Cytomegalovirus
c. Epstein-Barr virus
d. Hepatitis B virus
e. Varicella-zoster

26. Which of the following microbes is most likely to cause a
cerebrospinal fluid showing elevated protein and a
polymorphonuclear pleocytosis in late-stage HIV infection?
a. Toxoplasma gondii
b. Cytomegalovirus
c. Treponema pallidum
d. JC virus (Progressive multifocal leukoencephalopathy)
e. Herpes simplex

27. Which of the following microbes is most likely to cause a
cerebrospinal fluid showing elevated protein and a
polymorphonuclear pleocytosis in late-stage HIV infection?
a. Toxoplasma gondii
b. Cytomegalovirus
c. Treponema pallidum
d. 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 infection
b. Disseminated cytomegalovirus
c. Pneumocystis carinii pneumonia
d. Toxoplasmosis
e. 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 infection
b. Disseminated cytomegalovirus
c. Pneumocystis carinii pneumonia
d. Toxoplasmosis
e. Lymphoma

30. Which of the following fungi is an agent of disseminated
infections primarily in southeastern or eastern Asia?
a. Penicillium marneffei
b. Coccidioides immitis
c. Histoplasma capsulatum
d. Blastomyces dermatitidis
e. Paracoccidioides brasiliensis

31. Which of the following fungi is an agent of disseminated
infections primarily in southeastern or eastern Asia?
a. Penicillium marneffei
b. Coccidioides immitis
c. Histoplasma capsulatum
d. Blastomyces dermatitidis
e. 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 months
b. Advise the patient that she has early HIV infection
c. Perform testing on her sexual partner to determine if he is the source of
the infection
d. Test the patient's sexual partner for HIV
e. 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 months
b. Advise the patient that she has early HIV infection
c. Perform testing on her sexual partner to determine if he is the source of
the infection
d. Test the patient's sexual partner for HIV
e. 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 acyclovir
b. It will respond to treatment with ganciclovir
c. It is a rare complication of diseases other than HIV
infection
d. It is usually not treated
e. Scrapings of it will show pseudomycelia

35. All of the following are correct about hairy leukoplakia
except:
a. It will respond to treatment with acyclovir
b. It will respond to treatment with ganciclovir
c. It is a rare complication of diseases other than HIV
infection
d. It is usually not treated
e. 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. Pneumovax
b. Azithromycin prophylaxis
c. PCP prophylaxis
d. Hepatitis B vaccine
e. 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. Pneumovax
b. Azithromycin prophylaxis
c. PCP prophylaxis
d. Hepatitis B vaccine
e. 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 AZT
d. Tablets should be chewed or dissolved in fluids before
swallowing
e. 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 AZT
d. Tablets should be chewed or dissolved in fluids before
swallowing
e. 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 lymphadenopathy
b. Thrush
c. Pneumonia due to S. pneumoniae
d. Cavitary pulmonary tuberculosis
e. 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 lymphadenopathy
b. Thrush
c. Pneumonia due to S. pneumoniae
d. Cavitary pulmonary tuberculosis
e. 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. pneumoniae
b. Mycobacterium tuberculosis
c. Rhodococcus equii
d. P. carinii
e. 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. pneumoniae
b. Mycobacterium tuberculosis
c. Rhodococcus equii
d. P. carinii
e. 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. Lymphoma
b. Toxoplasmosis
c. Cryptococcosis
d. PML
e. 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. Lymphoma
b. Toxoplasmosis
c. Cryptococcosis
d. PML
e. Herpes simplex encephalitis

46. Which of the following does not have verified benefit in
reducing perinatal transmission?
a. Intrapartum nevirapine
b. Intrapartum AZT
c. Intrapartum indinavir
d. C-section
e. Reduction in viral load during pregnancy

47. Which of the following does not have verified benefit in
reducing perinatal transmission?
a. Intrapartum nevirapine
b. Intrapartum AZT
c. Intrapartum indinavir
d. C-section
e. 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. Salmonellosis
b. C. difficile colitis
c. Microsporidia
d. Irritable bowel syndrome
e. Kaposi's 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. Salmonellosis
b. C. difficile colitis
c. Microsporidia
d. Irritable bowel syndrome
e. Kaposi's 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. Efavirenz
b. Hydroxyurea
c. Abacavir
d. Saquinavir
e. Nelfinavir

51. Which of the following drugs has been associated with
serious hypersensitivity reactions characterized by
fever, GI distress, and rash?
a. Efavirenz
b. Hydroxyurea
c. Abacavir
d. Saquinavir
e. Nelfinavir

52. The opportunistic organism most likely to infect the adrenal
gland in patients with advanced HIV infection is:
a. M. avium
b. Histoplasma capsulatum
c. Candida albicans
d. CMV
e. Cryptococcus neoformans

53. The opportunistic organism most likely to infect the adrenal
gland in patients with advanced HIV infection is:
a. M. avium
b. Histoplasma capsulatum
c. Candida albicans
d. CMV
e. Cryptococcus neoformans

54. Which of the following is most likely to show no white blood
cells in cerebrospinal fluid?
a. Toxoplasma encephalitis
b. CNS lymphoma
c. Progressive multifocal leukoencephalopathy
d. Neurosyphilis
e. CMV encephalitis

55. Which of the following is most likely to show no white blood
cells in cerebrospinal fluid?
a. Toxoplasma encephalitis
b. CNS lymphoma
c. Progressive multifocal leukoencephalopathy
d. Neurosyphilis
e. 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 lab
b. Repeat the CD4-cell count, but use a different lab
c. Request a complete T-subset analysis
d. Obtain additional studies for HIV staging including B2
microglobulin and neopterin
e. 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 lab
b. Repeat the CD4-cell count, but use a different lab
c. Request a complete T-subset analysis
d. Obtain additional studies for HIV staging including B2
microglobulin and neopterin
e. 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. epidermidis
b. Microsporidia
c. Blastocystis hominis
d. Cryptosporidia
e. 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. epidermidis
b. Microsporidia
c. Blastocystis hominis
d. Cryptosporidia
e. 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 antigen
b. Routine serologic test
c. HIV DNA assay
d. HIV RNA level
e. 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 antigen
b. Routine serologic test
c. HIV DNA assay
d. HIV RNA level
e. HIV culture

62. The most common side-effect of nelfinavir is:
a. Epigastric pain
b. Diarrhea
c. Headache
d. Nephrolithiasis
e. Neuropathy

63. The most common side-effect of nelfinavir is:
a. Epigastric pain
b. Diarrhea
c. Headache
d. Nephrolithiasis
e. Neuropathy

64. A 32-year-old man with AIDS consults for fever, a rash of 3-5 days duration and
painful feet of two weeks duration. He had PCP eight months previously and has
subsequently received AZT, ddI, saquinavir, ketoconazole (200 mg/day),
trimethoprim-sulfamethoxazole (1 DS/day), and vitamin C (1 gm daily). He was
seen for a routine visit three weeks ago and was asymptomatic with a negative
physical exam and the following laboratory tests:
WBC 2,100/mm3 (75% PMN's, 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% PMS's, 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 this
patient?
a. AZT
b. Trimethoprim-sulfamethoxazole
c. Ketoconazole
d. ddI
e. Vitamin C

65. A 32-year-old man with AIDS consults for fever, a rash of 3-5 days duration and
painful feet of two weeks duration. He had PCP eight months previously and has
subsequently received AZT, ddI, saquinavir, ketoconazole (200 mg/day),
trimethoprim-sulfamethoxazole (1 DS/day), and vitamin C (1 gm daily). He was
seen for a routine visit three weeks ago and was asymptomatic with a negative
physical exam and the following laboratory tests:
WBC 2,100/mm3 (75% PMN's, 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% PMS's, 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 this
patient?
a. AZT
b. Trimethoprim-sulfamethoxazole
c. Ketoconazole
d. ddI
e. Vitamin C

66. Albendazole is effective therapy for most patients infected
by:
a. Toxoplasma gondii
b. Enterocytozoon bienusi
c. Septata intestinalis
d. Cryptosporidia
e. Cyclospora

67. Albendazole is effective therapy for most patients infected
by:
a. Toxoplasma gondii
b. Enterocytozoon bienusi
c. Septata intestinalis
d. Cryptosporidia
e. 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. IVIG
b. Prednisone
c. Splenic irradiation
d. Danazol
e. 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. IVIG
b. Prednisone
c. Splenic irradiation
d. Danazol
e. No treatment

72. Fecal leukocytes are most likely with diarrhea due to:
a. Mycobacterium
b. Septata intestinalis
c. Cryptosporidium
d. Isospora
e. Cytomegalovirus

73. Fecal leukocytes are most likely with diarrhea due to:
a. Mycobacterium
b. Septata intestinalis
c. Cryptosporidium
d. Isospora
e. Cytomegalovirus

74. A 28-year old gay man has progressive dyspnea and
hypoxemia over 2-3 months. He is afebrile and has a CD4
count of 26/mm3. Chest x-ray shows alveolar infiltrates
bilaterally, hilar adenopathy and a pleural effusion.
Bronchscopy with BAL and a transbronchial biopsy is
negative. A gallium scan negative. The most likely cause is:
a. Histoplasmosis
b. Coccidiodomycosis
c. Lymphocytic interstitial pneumonia
d. Lymphoma
e. Kaposi sarcoma

75. A 28-year old gay man has progressive dyspnea and
hypoxemia over 2-3 months. He is afebrile and has a CD4
count of 26/mm3. Chest x-ray shows alveolar infiltrates
bilaterally, hilar adenopathy and a pleural effusion.
Bronchscopy with BAL and a transbronchial biopsy is
negative. A gallium scan negative. The most likely cause is:
a. Histoplasmosis
b. Coccidiodomycosis
c. Lymphocytic interstitial pneumonia
d. Lymphoma
e. 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. Penicillin
b. Ciprofloxacin
c. Erythromycin
d. Cephalosporin
e. Vancomycin

78. Which of the following drugs is the most potent inhibitor of
the hepatic p450 metabolic pathway?
a. Ritonavir
b. Saquinavir
c. Rifampin
d. Nevirapine
e. Abacavir

79. Which of the following drugs is the most potent inhibitor of
the hepatic p450 metabolic pathway?
a. Ritonavir
b. Saquinavir
c. Rifampin
d. Nevirapine
e. Abacavir

80. Most patients in late-stage HIV infection develop
toxoplasmosis from which of the following?
a. New infection following exposure to cat stool
b. New infection following exposure to undercooked meat
c. New infection from exposure to a patient with
toxoplasmosis
d. New infection from contaminated water
e. 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 stool
b. New infection following exposure to undercooked meat
c. New infection from exposure to a patient with
toxoplasmosis
d. New infection from contaminated water
e. Activation of latent infection

82. Which of the following drugs have been associated with
hypertriglyceridemia?
a. Ritonavir
b. Hydroxyurea
c. Delavirdine
d. Abacavir
e. Stavudine (d4T)

83. Which of the following drugs have been associated with
hypertriglyceridemia?
a. Ritonavir
b. Hydroxyurea
c. Delavirdine
d. Abacavir
e. Stavudine (d4T)

84. Which of the following is not detected with AFB stain of
stool in patients with diarrhea?
a. Cryptosporidia parvum
b. Cyclospora cayetanensis
c. Isospora belli
d. Microsporidia
e. Septata intestinalis

85. Which of the following is not detected with AFB stain of
stool in patients with diarrhea?
a. Cryptosporidia parvum
b. Cyclospora cayetanensis
c. Isospora belli
d. Microsporidia
e. 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. pallidum
b. Toxoplasma gondii
c. Cryptococcus
d. Progressive multifocal leukoencephalopathy
e. 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. pallidum
b. Toxoplasma gondii
c. Cryptococcus
d. Progressive multifocal leukoencephalopathy
e. 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. Giardia
b. E. histolytica
c. C. difficile
d. Salmonella
e. Cryptosporidia

89. A 32-year-old woman with HIV infection complains of
in
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itt
e
nt
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ea
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