rapid revision for indian medical exams like neet, fmge, jipmer and cee.

1. INFECTIOUS DISEASES

2. • A 37 year old man with a CD4 count of 24cells/mm3 presents with painless,
progressive visual loss. On fundoscopy the vitreous is clear, and
haemorrhages and exudates are seen on the retina. What is the most likely
diagnosis?
• A. Cytomegalovirus retinitis
• B. HIV retinopathy
• C. Ocular syphilis
• D. Ocular toxoplasmosis
• E. Progressive outer retinal necrosis due to varicella zoster virus

3. • What is the mechanism of action of the antiretroviral drugs raltegravir,
dolutegravir and elvitegravir?
• A. Chemokine receptor CCR5 antagonist
• B. Fusion inhibitor
• C. lntegrase inhibitor
• D. Protease inhibitor
• E. Reverse transcriptase inhibitor

4. • A 44 year old woman with a CD4 count of 73cells/mm3 presents with a
progressive left hemiplegia and headache over a week. Her magnetic
resonance imaging scan shows multiple ring-enhancing mass lesions with
surrounding cerebral oedema. What is the most likely diagnosis?
• A. Brain abscess
• B. Cerebral toxoplasmosis
• C. Cryptococcoma
• D. Primary central nervous system (CNS) lymphoma
• E. Tuberculoma

5. • What is the correct statement regarding the immune reconstitution
inflammatory syndrome (IRIS)?
• A. Antiretroviral therapy (ART) should be stopped if IRIS is suspected
• B. It is more common in patients responding poorly to ART
• C. It is more common when ART is initiated with higher baseline CD4 counts
(> 200 cells/mm3)
• D. It usually presents within the first 3 months of initiating ART
• E. The mortality is high (approximately 25%)

6. • A 26 year old woman with newly diagnosed HIV infection and a CD4+
lymphocyte count of 34cells/mm3 presents with dysphagia. There is no oral
candidiasis. You prescribe a course of fluconazole for possible Candida
oesophagitis. Two weeks later she returns with no improvement. What is the
most likely cause of her dysphagia?
• A. Cytomegalovirus oesophageal ulceration
• B. Herpes simplex virus oesophageal ulceration
• C. Kaposi's sarcoma of the oesophagus
• D. Major aphthous ulceration of the oesophagus
• E. Oesophagitis to azole-resistant Candida species (e.g. C. kruse!)

7. • A 39 year old man presents with asymmetric cervical lymphadenitis for 2
months. His CD4 count is 234cells/mm3. The largest node is 4x3 cm and is
fluctuant. Several nodes are matted together. What is the most likely
diagnosis?
• A. HIV lymphadenopathy
• B. Kaposi's sarcoma
• C. Non-Hodgkin lymphoma
• D. Pyogenic lymphadenitis
• E. Tuberculosis

8. • Which of the following statements is correct about AIDS-associated
Kaposi’s sarcoma?
• A. It is a spindle-cell tumour of lymphoendothelial origin
• B. It is associated with infection by human herpesvirus 6
• C. Multiple skin lesions indicate a poor prognosis
• D. The commonest site of visceral spread is the brain

9. • Which of the following features is characteristic of HIV-associated
nephropathy (HIVAN)?
• A. Heavy proteinuria (> 1 .5 g/24 hrs) is a usual finding
• B. Severe hypertension is a characteristic feature
• C. Small kidneys on ultrasound are typically seen when the creatinine
clearance decreases to 30 mUmin or less
• D. The course of the disease is relatively benign with few progressing to
end-stage renal failure

10. • A 53 year old lawyer who is human immunodeficiency virus (HIV)seropositive
has a medical review, which reveals a positive interferon-gamma release assay
(IGRA), showing T cells reactive to Mycobacterium tuberculosis antigens. He is
asymptomatic and a chest X-ray is reported as negative. Which of these most
accurately describes his mycobacterial status?
• A. Active pulmonary disease
• B. Commensal flora
• C. Extrapulmonary infection
• D. Latent infection
• E. Opportunistic infection

11. • A 35 year old doctor returns to visit his family in rural India. Two weeks later
he develops a fever, which progresses over a number of days to high-grade
fever, in association with profound malaise. He develops a dry cough and
subsequently diarrhoea. On examination a spleen tip is palpable. Blood
cultures identify a Gram-negative rod, which is still being identified to the
species level. While antimicrobial sensitivities are being determined, which
one of the following antimicrobial agents should form initial empirical
treatment?
• A. Ceftriaxone
• B. Chloramphenicol
• C. Ciprofloxacin
• D. Co-amoxiclav
• E. Co-trimoxazole

12. • A 34 year old woman who takes prednisolone and azathioprine for control of
her Crohn's disease presents with a 10-day history of headache and double
vision. On examination she has meningism and a 3rd nerve palsy. CSF
shows a white cell count of 500 cells/mm3, which are predominately
lymphocytes, an elevated protein and low glucose. Special stains and
antigen tests are negative. What is the likeliest infecting organism?
• A. Cryptococcus neoformans
• B. Listeria monocytogenes
• C. Neisseria meningitidis
• D. Streptococcus pneumoniae

13. • A 32 year old man presents with a 5-day history of left -sided pleuritic chest
pain, fever and cough productive of rusty sputum. Observations include: BP
100/60 mmHg, pulse 105 beats/min, temperature 38.2°C, respiratory rate 21
breaths/min, oxygen saturations 87% on room air. Examination reveals
dullness to percussion and bronchial breathing on the left. Nasolabial cold
sores are noted. Which organism is likely to be responsible for this
presentation?
• A. Aspergillus fumigatus
• B. Herpes simplex virus (HSV)
• C. Mycobacterium tuberculosis
• D. Pneumocystis jirovecii
• E. Streptococcus pneumoniae

14. • A 54 year old man is due to start a monoclonal antibody-based therapy for
active Crohn's disease but the radiologist has noted a minor abnormality on
the patient's recent CXR. The patient had a bacille Calmette-Guerin (BCG)
vaccine in childhood and has no known TB contacts. He has no respiratory
symptoms. Local guidance suggests checking an interferon-gamma release
assay (IGRA) on a peripheral blood sample. Which one of the following
statements is true with regard to the IGRA?
• A. A positive result should prompt the clinician to start antituberculous
chemotherapy
• B. It is more specific than tuberculin skin testing
• C. It is now the first-line test for diagnosis of active TB
• D. It is only positive where there is systemic mycobacterial infection
• E. It measures the release of interferon-alpha from sensitised T cells

15. • A 34 year old human immunodeficiency virus (HIV)-positive man who has sex
with men (MSM) complains of severe rectal pain, blood-stained discharge and
tenesmus. He is taking antiretroviral therapy, has a CD4 count of 636 and an
undetectable HIV viral load. Proctoscopy reveals rectal inflammation and
visible mucopus. Which is the most likely cause of this presentation?
• A. Campylobacter infection
• B. Cytomegalovirus colitis
• C. Gonorrhoea
• D. Lymphogranuloma venereum
• E. Secondary syphilis

16. • What is human immunodeficiency virus (HIV) protease enzyme
responsible for?
• A. Budding of HIV from the cell
• B. Cleavage of post-translational regulatory proteins
• C. Fusion of HIV with the host cell surface
• D. Integration of viral deoxyribonucleic acid (DNA) into the host
genome
• E. Reverse transcription of viral ribonucleic acid (RNA) to DNA

17. • What is the risk of acquiring HIV during a single act of unprotected vaginal
sexual intercourse when the male partner is HIV infected and not on
antiretroviral therapy, and the female partner is HIV uninfected?
• A. 0.001%
• B. 0.01%
• c. 0.1%
• D.1%
• E. 10%

18. • What is the most sensitive blood test for diagnosing HIV during primary
infection?
• A. HIV antibodies detected by enzyme-linked immunosorbent assay
• B. HIV antibodies detected by western blot
• C. p24 antigen detection
• D. Polymerase chain reaction (PCR) to detect HIV RNA
• E. Rapid point -of-care antibody test

19. • A 35 year old HIV-positive man presents with diarrhoea of 4 weeks'
duration accompanied by tenesmus. Blood and mucus is present in the
stool. He is not on antiretroviral therapy. His CD4 count is 17
cells/mm3.Which of the following is the most likely diagnosis?
• A. Cryptosporidiosis
• B. Cysto isosporiasis
• C. Cytomegalovirus (CMV) colitis
• D. Giardiasis
• E. Microsporidiosis

20. • Which one of the following non-acquired immunodeficiency
syndrome (non-AIDS) cancers has been shown to have an increased
incidence in HIV-infected patients?
• A. Anal cancer
• B. Breast cancer
• C. Melanoma
• D. Ovarian cancer
• E. Prostate cancer

21. • An HIV-infected woman with a CD4 count of 36cells/mm3 presents with
symptomatic anaemia. She is not on antiretroviral therapy. Full blood count
shows: haemoglobin 26 g/L, normochromic and normocytic, with a low
reticulocyte index; white cell count and platelets are normal. Bone marrow
biopsy shows pure red cell aplasia. Which one of the following viral infections
is likely to be responsible?
• A. Cytomegalovirus
• B. Epstein-Barr virus
• C. Herpes simplex virus
• D. JC virus (John Cunningham virus)
• E. Parvovirus B19

22. • Which of the following is a clinical indication for starting prophylactic
co-trimoxazole in HIV-infected adults in middle- to high-income
settings?
• A. Enlarged parotid glands
• B. Fungal nail infections
• C. Generalised lymphadenopathy
• D. Herpes zoster infection
• E. Oral hairy leucoplakia

23. • A 24 year old HIV-infected man presents with a 5-day history of fever, cough
and right pleuritic chest pain. There are crackles and signs of consolidation in
the right lung posteriorly and chest radiograph shows dense consolidation of
the right lower zone. What is the most likely pathogen?
• A. Mycobacterium tuberculosis
• B. Pneumocystis jirovecii
• C. Pseudomonas aeruginosa
• D. Streptococcus pneumoniae
• E. The 'atypical bacteria'

24. • Which of the following statements is true about the diffuse inflammatory
lymphocytosis syndrome (DILS)?
• A. DILS is a recognised complication of co-infection with human herpesvirus 8
• B. DILS is a risk factor for parotid gland lymphoma
• C. DILS is associated with polymyositis
• D. DILS is characterised by infiltration of the parotids with B lymphocytes
• E. DILS is usually associated with a marked C04 lymphocytosis

25. • A nurse administers an intramuscular injection to an HIV-infected
woman who is not yet on antiretroviral therapy. After the injection she
pricks her finger on the needle. What is the approximate risk of
acquiring HIV following this occupational exposure?
• A. 0.003%
• B. 0.03%
• c. 0.3%
• D. 3%
• E. 30%