Hiv aids sample questions based on neet pg , usmle, plab and fmge pattern (mci screening)2

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Which of the following is the MOST common cause of sporadic viral encephalitis in
adults?
A: Herpes virus
B: Enteroviruses
C: EbsteinBarr virus
D: HIV
Correct Ans:A
Explanation
The most commonly identified viruses causing sporadic cases of acute encephalitis in
adults are herpesviruses (HSV, VZV, EBV).
Note Frequently Asked: Enteroviruses (coxsackieviruses, echoviruses, and human
enteroviruses 68–71) are the most commonly identified viruses causing sporadic cases of
acute meningitis.
Ref: Roos K.L., Tyler K.L. (2012). Chapter 381. Meningitis, Encephalitis, Brain Abscess,
and Empyema. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J.
Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e
Sample Previous Year Question on HIV based on previous Year Questions of NEET PG,
USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such
Quizzes
HIV virus has a particularly high affinity for which of the following?
A: CD4 T Lymphocytes and B cells

B: CD4 T Lymphocytes and monocytes
C: CD8 T Lymphocytes and B cells
D: CD8 T Lymphocytes and CD4 T Lymphocytes
Correct Ans:B
Explanation
HIV has a particular tendency to bind to CD4 T lymphocytes (helper T lymphocytes) and
monocytes and then become internalized. Most other cells, include CD8 T lymphocytes
(suppressor T cells) and B cells, are not particularly susceptible to the HIV virus.
HIV preferentially infects and kills helper (CD4) T lymphocytes, resulting in the loss of
cellmediated immunity and a high probability that the host will develop opportunistic
infections. Other cells (e.g., macrophages and monocytes) that have CD4 proteins on
their surfaces can be infected also.

Also know:
The genome of HIV consists of two identical molecules of singlestranded, positive
polarity RNA and is said to be diploid.

In addition to the three typical retroviral genes gag, pol, and env, which encode the
structural proteins, the genome RNA has six regulatory genes. Two of these regulatory
genes, tat and rev, are required for replication, and the other four, nef, vif, vpr, and vpu,
are not required for replication and are termed “accessory" genes.
Ref: Levinson W. (2012). Chapter 45. Human Immunodeficiency Virus. In W. Levinson
(Ed), Review of Medical Microbiology & Immunology, 12e.
Quizzes
What is the chance of HIV infection after needle prick injury?
A: 1/100
B: 1/300
C: 1/10000

D: 1 in 1 Lakh
Correct Ans:B
Explanation
Needle prick injury: HIV transmission following skin puncture from a contaminated
needle is 0.3 % and a mucous membrane exposure is 0.09%. The seroconversion rate for
HIV is 1:300, or 0.3% from a hollowbore needle stick injury. Antiretroviral drugs as
postexposure prophylaxis decreases the risk of infection.
Must know:
In Hepatitis B, the seroconversion ranges from 23 to 62%, with higher rates associated
with patients who are HBeAg positive, as compared to HBeAG negative. The
seroconversion rate for Hepatitis C is 1.8%.For Hepatitis C no prophylactic treatment is
available. HBV post exposure prophlylaxis with hepatitis B immunoglobulin and
initiation of Hep B vaccine is 90%effective.
Ref: Harrison’s Principles of internal medicine, 16th edition, page 1081.
Quizzes
A 24yearold man is infected with HIV during a sexual encounter with a prostitute. He
does not notice any symptoms in the period immediately after the encounter. During the
asymptomatic latent phase of his infection, the virus is actively proliferating, and can be
found in association with which of the following?
A: B lymphocytes
B: Follicular dendritic cells in lymph nodes
C: Ganglion cells
D: Oligodendrocytes
Correct Ans:B

Explanation
Follicular dendritic cells in the germinal centers of lymph nodes are important reservoirs
of HIV. Although some follicular dendritic cells are infected with HIV, most viral
particles are found on the surface of their dendritic processes. Follicular dendritic cells
have receptors to the Fc portion of immunoglobulins that serve to trap HIV virions
coated with antiHIV antibodies. These coated HIV particles retain the ability to infect
CD4+ T cells as they traverse the dendritic cells.
B lymphocytes have a surface marker (CD21 proteina complement receptor) to which
an EpsteinBarr envelope glycoprotein can bind. The virus associates with the host cell
genome, producing a latent infection. These B cells undergo polyclonal activation and
proliferation.
Ganglion cells, particularly the satellite cells around the ganglion cells in the dorsal root
ganglia, can be infected by varicellazoster. Herpes type I and II infect neurons that
innervate skin and mucous membranes.
Oligodendrocytes are directly infected by two viruses, JC virus (a polyomavirus) and
measles virus. JC virus causes progressive multifocal leukoencephalopathy (PML), and
measles virus produces a latent syndrome called subacute sclerosing panencephalitis
(SSPE).

Ref: Levinson W. (2012). Chapter 58. Cellular Basis of the Immune Response. In W.
Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.
Quizzes
During preoperative investigations, a man found to have positive serological results for
HIV. Which of the following is highly specific test for HIV antibodies in this patient?
A: ELISA
B: Southern blot
C: Northern blot
D: Western blot
Correct Ans:D
Explanation
The Western blot test is used as a measure of specific HIV1 antibodies to confirm a positive

ELISA result. The criterion for a positive test is any two bands corresponding to p24,
gp41, and gp120/160. The absence of bands is a negative result, whereas the presence of
bands that do not meet the criterion for a positive test is an indeterminate result. False
positive and falsenegative results are relatively uncommon.

HIV2infected patients may give an unusual pattern on an HIV1 Western blot;
therefore, if HIV2 is suspected, a separate HIV2 Western blot is required.
Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 47.
Principles of Diagnostic Medical Microbiology. In G.F. Brooks, K.C. Carroll, J.S. Butel,
S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology,
26e.
Quizzes
A 28yearold HIVpositive male complains of pain on swallowing. Physical examination
is remarkable for white plaquelike material on his tongue and buccal mucosa, which is
scraped and sent to the laboratory. Based on these findings, and on the laboratory
results, the man is diagnosed with acquired immunodeficiency syndrome (AIDS). With
which of the following agents is the man most likely infected?
A: Candida albicans
B: Cytomegalovirus
C: Herpes simplex I
D: Human herpesvirus 8
Correct Ans:A
Explanation
Candida albicans produces oral thrush, an AIDSdefining lesion, which is common in
acute HIV disease, and becomes increasing common as the CD4 + cell count falls. The
lesions are usually painless. Diagnosis is by demonstration of pseudohyphae using a wet
smear with confirmation by culture.
Although cytomegalovirus is associated with numerous clinical scenarios in the AIDS
population, including odynophagia (painful swallowing), it would not produce white
plaques on the oral mucosa.


Herpes Simplex Iproduces vesicular lesions occurring in clusters in the oral cavity. There
is an increased risk of herpes infections in the AIDS group, but the lesions do not
resemble those described in the question.

Human herpesvirus 8 is the causative agent of Kaposi's sarcoma, a malignancy arising
from endothelial cells that appears as hemorrhagic nodules in different organ systems. It
is the most common cancer in the HIV infected population.
Quizzes
With needle stick injury, there is risk of transmitting all of the following infections,
EXCEPT:
A: HIV
B: HBV
C: HCV
D: HDV
Correct Ans:D
Explanation
Most common infections spread through needle stick injury are HIV, HBV and HCV.
HDV infection occur only in the presence of HBV. It is transmitted through parenteral
exposure or intimate contact. Vertical HDV transmission is rare.
HBV is the most infectious of the 3 viruses.
There is about 2% risk of acquiring HCV infection after needle stick injury. The is
no vaccine against HCV and no treatment can prevent infection after exposure to
the virus.
The risk of acquiring HIV is less than 0.5% after a single needle stick injury
involving a patient known to have HIV/AIDS in a healthcare setting.
The risk of HIV transmission from an infected patients blood or other body fluid
splashed into a caregivers eyes or mouth is much lower than for needle stick
injuries.
Ref: Levin M.J., Weinberg A. (2012). Chapter 40. Infections: Viral & Rickettsial. In
W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds),

CURRENT Diagnosis & Treatment: Pediatrics, 21e, Sokol R.J., Narkewicz M.R. (2012).
Chapter 22. Liver & Pancreas. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross,
J.M. Sondheimer (Eds),CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Quizzes
What are the chances of contracting HIV after needle prick injury?
A: 1/100
B: 1/300
C: 1/10000
D: I in 1 Lac
Correct Ans:B
Explanation
The average risk of HIV infection following needle prick injury is 1/300. After
mucocutaneous exposure risk is approximately 0.09%. Post exposure prophylaxis should
be initiated within 12 hrs.

According CDC guidelines:
A basic regimen consists of twodrug therapy, often consisting of azidothymidine
and lamivudine.
In an expanded regimen: indinavir or nelfinavir is added to it.
HBV is the most infectious of the 3 viruses.
There is about 2% risk of acquiring HCV infection after needle stick injury. The is
no vaccine against HCV and no treatment can prevent infection after exposure to
the virus.
The risk of HIV transmission from an infected patients blood or other body fluid
splashed into a caregivers eyes or mouth is much lower than for needle stick
injuries.
Ref: Rothman R.E., Marco C.A., Yang S. (2011). Chapter 149. Human
Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. In R.K.
Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study
Guide, 7e.

Quizzes
Primary Receptor for Human Immunodeficiency Virus (HIV) is:
A: CD4
B: CD8
C: CD3
D: CD56
Correct Ans:A
Explanation
HIV targets cells that express CD4, and can infect macrophages, dendritic cells (both
groups express CD4 at low levels) and CD4+ T cells.
Ref: Andrew E. Williams, “Immunology of Urogenital Tract and Conjunctiva”, In the
book, “Immunology: Mucosal and Body Surface Defences”, USA, Wiley Blackwell
Publications, Chapter 9.1; Harrison’s Principles of Internal Medicine, 17th Edition,
Pages 1139, 1157; Textbook of Microbiology By Ananthnaraynan, 7th Edition, Page 586
Quizzes
Most common genital lesion in HIV patient is:
A: Chlamydia
B: Herpes

C: Syphilis
D: Candida
Correct Ans:B
Explanation
Herpes simplex virus is the is the most common opportunistic infection causing genital
lesions in HIV patients. Herpes simplex virus type I and Type II cause recurrent oral,
labial, genital and perianal herpes simplex lesions in HIV infected individuals. Herpes
simplex virus type II (HSV2) is associated with genital lesions.

Ref: Diagnosis and Management of HIV/AIDS : A Clinician's Perspective By Usha K.
Baveja, B. B. Rewari, Page 93; Centers for Disease Control and Prevention. 2006
Sexually Transmitted Diseases Treatment Guidelines. MMWR Recomm Rep 2006;
55(RR11), Pages 1 94.
Quizzes
A 38yearold man has been HIVpositive since the age of 26 but has refused
antiretroviral prophylaxis. His CD4 cell count, however, is still within normal limits, and
the virus is undetectable in the blood. Genetic investigations clarify this apparent puzzle,
demonstrating that this subject is homozygous for a mutation affecting a chemokine
receptor necessary for HIV entry into the cell. Which of the following receptors is most
likely involved?
A: CCR5
B: CD4
C: CD8
D: Gp120
Correct Ans:A
Explanation
HIV infection does not always progress to overt AIDS. In a few fortunate individuals
(called nonprogressors), the infection remains asymptomatic, with a stable CD4 cell

count and low or undetectable viremia. It is not entirely clear whether these patients will
eventually develop AIDS. Some are resistant to HIV infection because they carry two
defective copies of the gene encoding the CCR5 coreceptor. There are 15 known
coreceptors, of which CCR5 and CXCR4 are the best characterized. CCR5 is a receptor
for βchemokines and serves as a coreceptor for HIV internalization. Approximately one
percent of Caucasians in the U.S. is homozygous for such a protective CCR5 variant, and
20% are heterozygotes.
HIV infection follows a slower course in heterozygotes. Homozygotes for this protective
CCR5 variant are not present among Black and Asian populations. Recently, a variant
haplotype of CXCR1 (a leukocyte receptor for fractalkine) has been linked to rapid
progression of HIV infection in homozygous individuals. Thus, investigations on HIV
coreceptors are beginning to explain the variability in progression and severity of HIV
infection among individuals.
CD4 (2nd Choice) is an important receptor of helper T lymphocytes, macrophages, and
Langerhans cells. It acts as the primary receptor for HIV binding. Binding to CD4,
however, is not sufficient for the entry of HIV into the cells.
The viral envelope gp120 protein (4th Choice) first binds CD4. This results in a
conformational change in gp120 that allows this protein to bind coreceptors. Such
coreceptors are present on lymphocytes and macrophages and normally serve as binding
sites for chemokines. Once gp120 binds to CD4 and a coreceptor, a second viral protein,
gp41, facilitates fusion of the viral envelope with the plasma membrane, allowing
"injection" of the viral core into the cell.
Neither CD8 (5th Choice) nor the receptor for TNFα plays a role in HIV binding to cells.
Quizzes
A 24yearold sex worker from Mumbai develops chronic abdominal pain, lowgrade
fever, diarrhea, and malabsorption. He saw later found to be positive for HIV. Oocysts
are demonstrated in the stool. Which of the following organisms is most likely to be the
cause of the patient's diarrhea?
A: Diphyllobothrium latum
B: Entamoeba histolytica
C: Giardia lamblia

D: Isospora belli
Correct Ans:D
Explanation
All of the organisms listed are protozoa. There are two intestinal protozoa specifically
associated with AIDS that can cause transient diarrhea in immunocompetent individuals
but can cause debilitating, and potentially lifethreatening chronic diarrhea in AIDS
patients. These organisms are Isospora belli, treated with trimethoprim
sulfamethoxazole (or other folate antagonists) and Cryptosporidium parvum.
Diphyllobothrium latum is the fish tapeworm and occasionally causes diarrhea.
Entamoeba histolytica and Giardia lamblia are both causes of diarrhea, but they are not
specifically associated with AIDS.
Quizzes
HIV patient is admitted with malabsorption, fever, chronic diarrhoea and acid fast
positive organism. What is the likely causative agent?
A: Giardia
B: Microsporidia
C: Isospora
D: E. histolytica
Correct Ans:C
Explanation
The coccidian parasite Isospora belli causes human intestinal disease. Infection is
acquired by the consumption of oocysts, after which the parasite invades intestinal
epithelial cells and undergoes both sexual and asexual cycles of development. Oocysts
excreted in stool are not immediately infectious but must undergo further maturation.
In patients who have AIDS, infections often are not selflimited but rather resemble
cryptosporidiosis, with chronic, profuse watery diarrhea. Eosinophilia, which is not found

in other enteric protozoan infections, may be detectable.

The diagnosis is usually made by detection of the large (25m) oocysts in stool by
modified acidfast staining. Oocyst excretion may be lowlevel and intermittent; if
repeated stool examinations are unrevealing, sampling of duodenal contents by
aspiration or smallbowel biopsy (often with electronmicroscopic examination) may be
necessary.

Ref: Weller P.F. (2012). Chapter 215. Protozoal Intestinal Infections and Trichomoniasis.
In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),
Harrison's Principles of Internal Medicine, 18e
Quizzes
A 31 year old HIVpositive man develops a severe pneumonia. Lower respiratory tract
secretions obtained by fiberoptic bronchoscopy with bronchoalveolar lavage and stained
with methenamine silver stain demonstrate cupshaped cysts with sharply outlined walls.
Which of the following organisms is the most likely pathogen in this case?
A: Candida albicans
B: Giardia lamblia
C: Haemophilus influenzae
D: Pneumocystis carinii
Correct Ans:D
Explanation
The organism described is Pneumocystis carinii, which is an opportunistic parasite that
appears to be more closely related to fungi than to protozoa. Its cyst form, when stained
with silver stains, has the distinctive appearance described in the question stem, and is
typically found in frothy material that occupies the lumen of alveoli. The trophozoites are
smaller and much harder to recognize. Bronchoalveolar lavage is considered much more
reliable than induced sputum as a diagnostic specimen.
Pneumocystis pneumonia is a common infection among AIDS patients, and is very
uncommon in other clinical settings. Formerly, many AIDS patients died with
Pneumocystis pneumonia, but the combination of early drug treatment (with
trimethoprim/sulfamethoxazole or pentamidine) and prophylaxis (usually with

trimethoprim/sulfamethoxazole) has decreased the number of fatal infections. In severe
cases, Pneumocystis infection can sometimes be demonstrated in extrapulmonary sites.

Candida albicans(choice A) can infect the lung and stain with methenamine silver, but
the description of the lavage material would probably include the terms fungal hyphae
and yeast forms.

Giardia lamblia (choice B) causes diarrhea, rather than pneumonia.

Haemophilus influenzae(choice C) and Streptococcus pneumoniae(choice E) are bacteria
and would not stain with silver stains.

Ref: Levinson W. (2012). Chapter 52. Blood & Tissue Protozoa. In W. Levinson
(Ed),Review of Medical Microbiology & Immunology, 12e.
Quizzes
A terminally ill HIV infected patient develops focal neurologic signs, dementia, and
coma. Amoebic parasites are demonstrated in CSF. Which of the following organisms is
most likely to be the causative agent?
A: Acanthamoeba sp
B: Entamoeba histolytica
C: Giardia lamblia
D: Naegleria fowleri
Correct Ans:A
Explanation
Two types of freeliving amoeba can infect the brain and meninges: Naegleria fowleri
and Acanthamoeba species. The former affects healthy adolescent or adult divers, while
the latter causes infection in patients with immunosuppression because of diabetes,
alcoholism, cancer, or HIV infection. The brain infection characteristically has a
prominent perivascular character, which causes a multifocal hemorrhagic necrotizing
meningoencephalitis.
Skin ulcers, nasal infection, or pneumonia may also be present. It is thought that the
organisms may release a toxin causing host tissue necrosis. Systemic antifungal agents

(e.g., amphotericin) have some activity against this organism, but most cases are fatal.
Entamoeba histolytica causes amoebic dysentery and liver abscess. Giardia lamblia is a
flagellate, rather than an amoeba, and causes diarrhea.

Naegleria fowleri is an amoebic cause of meningoencephalitis in previously healthy
swimmers and divers.

Ref: Ray C.G., Ryan K.J. (2010). Chapter 51. Rhizopods. In C.G. Ray, K.J. Ryan (Eds),
Sherris Medical Microbiology, 5e.
Quizzes
All are caused by RNA viruses, EXCEPT:
A: HIV
B: Dengue
C: Herpangina
D: Fifth disease
Correct Ans:D
Explanation
Fifth disease also known as erythema infectiosum is caused by erythovirus (Parvovirs)
B19. Parvoviruses are linear, non segmented single stranded DNA virus.
The various manifestations of human parvovirus B19 infection is;
Erythema infectiosum (fifth disease)
Polyarthritis
Aplastic crisis
Chronic anemia
Congenital infection (anemia or hydrops fetalis)
Ref: Oski's Pediatrics: Principles And Practice, edited by Julia A. MacMillan, Ralph
David Feigin, 4 th Edition, Page 1230

Quizzes
A 24yearold man presents with fever, rash, a mild headache, and a sore throat. He
denies HIV risk factors, although he is sexually active. On examination, his temperature
is 100.8°F and his pulse is 90/min. There is a diffuse, erythematous, maculopapular rash
over most of his body. Generalized adenopathy is appreciated, and photophobia is noted
when funduscopic examination is attempted. If this man is not treated, which of the
following changes in his serologic status will most likely occur?
A: The FTAABS titer would fall
B: The FTAABS titer would rise
C: The VDRL titer would fall
D: The VDRL titer would rise
Correct Ans:C
Explanation
This is a case of syphilis, which is diagnosed serologically, using either treponemal and
nontreponemal tests. The FTAABS (fluorescent treponemal antibodyabsorbed test) is
the most widely used of the specific tests and depends on fluorescent labeling of the
organisms with antitreponemal antibody. The specific tests tend to rise early in titer and
stay elevated throughout the lifetime of the host, or at least until well after drug therapy
has been completed. The VDRL (Venereal Disease Research Laboratory) is a
nontreponemal test that detects antibodies that crossreact with mammalian cardiolipin
called reaginic antibodies. This test will become positive after the specific test, and its
titer will fall late in infection, with or without drug therapy.
The FTAABS titer would fall is incorrect because this titer will remain high throughout
the life of the host, falling off only very slowly after drug cure.
The FTAABS titer would rise is incorrect because the specific antibody test will reach a
high positive titer and remain at that level in untreated late stage syphilis.
The VDRL titer would rise is incorrect because reaginic antibody levels will fall in late
stage syphilis, with or without drug treatment.
Ref: Lukehart S.A. (2012). Chapter 169. Syphilis. In D.L. Longo, A.S. Fauci, D.L.
Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal
Medicine, 18e

Quizzes
A man presents to a dermatologist because of a severe mucocutaneous rash that involves
most of his body,including his palms and soles. Questioning reveals that he is a merchant
marine who several months previously had an encounter with a prostitute in Southeast
Asia. Which of the following is the most likely causative agent of this rash?
A: Herpes simplex I
B: Herpes simplex II
C: HIV
D: Treponema pallidum
Correct Ans:D
Explanation
The rash described is that of secondary syphilis, caused by Treponema pallidum.
Involvement of palms and soles by a rash is unusual, and secondary syphilis should come
to mind. Not all patients with secondary syphilis have a severe form of the rash, and
consequently some cases are missed. Primary syphilis takes the form of a painless,
buttonlike mass called chancres. Tertiary syphilis, which is now rare, has a propensity
for involving the aorta and central nervous system and can also cause "gummas"
(granulomatouslike lesions) in many sites, notably including liver and bone.

Herpes simplex I usually causes perioral

Herpes simplex II usually causes genital vesicular lesions.

HIV does not itself cause a rash, although coinfection with other organisms can result in
a rash.

Ref: Ray C.G., Ryan K.J. (2010). Chapter 37. Spirochetes. In C.G. Ray, K.J. Ryan (Eds),
Sherris Medical Microbiology, 5e.
Quizzes

A 23yearold, illappearing woman comes to the emergency room with a fever. She notes
the recent development of nausea, diarrhea, and a rash. Her last menstrual period began
3 days ago.Physical examination is remarkable for blood pressure of 90/45 mm Hg and
heart rate of 120 beats per minute. A diffuse erythematous rash with areas of
desquamation over the hands and feet is noted. Infection with which of the following
agents is the most likely cause of these signs and symptoms?
A: Clostridium perfringens
B: HIV1
C: Shigella dysenteriae
D: Staphylococcus aureus
Correct Ans:D
Explanation
This patient has toxic shock syndrome (TSS), a multisystem syndrome caused by a toxin
(TSST1) formed by certain strains of S. aureus. TSS usually affects several organ
systems (gastrointestinal, renal, hepatic, hematopoietic, musculoskeletal, pulmonary) and
can result in death. TSS has historically been associated with the use of tampons in young
women, but can also occur in other patient populations.
Fever, hypotension, diarrhea, and diffuse rash with desquamation of the hands and feet
are common symptoms. Management of shock, renal failure, and adult respiratory
distress syndrome (ARDS) are a priority if these
conditions are present, in addition to appropriate antibacterial treatment.

C. perfringens causes gas gangrene, with necrosis of soft tissues, usually after a traumatic
wound. It is also a cause of food poisoning.

Although HIV1 can cause many diverse findings and should never be immediately ruled
out, the findings in this patient are most specific for TSS.

Shigella dysenteriae is a cause of dysentery characterized by fever, abdominal cramps,
and bloody diarrhea.

Ref: Ray C.G., Ryan K.J. (2010). Chapter 24. Staphylococci. In C.G. Ray, K.J. Ryan
(Eds), Sherris Medical Microbiology, 5e.

Quizzes
A 33 year old HIVpositive male complains of headache and blurred vision. Physical
exam reveals papilledema and ataxia. Head CT is normal but CSF obtained by lumbar
puncture reveals encapsulated organisms observable with India ink. Which of the
following is true concerning this organism?
A: It can also be identified with methenamine silver stain
B: It consists of branching septate hyphae
C: It exists as a mycelial form at room temperature and as yeast at 37° C
D: It is an encapsulated non dimorphic yeast found worldwide
Correct Ans:D
Explanation
This patient has cryptococcal meningitis, as evidenced by the "encapsulated organisms
observable with India ink" in the CSF (a classic clue). Cryptococcus is a non dimorphic
yeast, meaning that it exists only in the yeast form. It is encapsulated (that's why the
India ink stain works so well) and it reproduces by budding. It is found worldwide in
bird droppings (think pigeons). It can also cause transient pulmonary illness in otherwise
healthy individuals.

The methenamine silver stain is used primarily to demonstrate Pneumocystis carinii in
tissues.

Branching septate hyphae are characteristic of Aspergillus fumigatus, among other
fungi.
Mycoses that exist in mycelial and yeast forms (dimorphism; diphasic;) are Histoplasma
capsulatum, Coccidioides immitis, Blastomyces dermatidis, and Sporothrix schenckii.

Ref: Ray C.G., Ryan K.J. (2010). Chapter 46. Cryptococcus, Histoplasma, Coccidioides,
and Other Systemic Fungal Pathogens. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical
Microbiology, 5e.
Quizzes
All are indicators of goal 6 of Millennium Development Goal, EXCEPT:

A: HIV prevalence among women aged 1549 years
B: Number of children orphaned by HIV/AIDS
C: Prevalence and death rates of tuberculosis
D: Prevalence and death rates of malaria
Correct Ans:A
Explanation
Goal: 6. Combat HIV/AIDS, malaria and other diseases
18. HIV prevalence among young people aged 15 to 24 years

19. Condom use rate of the contraceptive prevalence rate

20. Number of children orphaned by HIV/AIDS

21. Prevalence and death rates associated with malaria

22. Proportion of population in malariarisk areas using effective malaria prevention and
treatment measures

23. Prevalence and death rates associated with tuberculosis

24. Proportion of tuberculosis cases detected and cured under Directly Observed
Treatment, Shortcourse (DOTS)
Ref: Park’s textbook of Preventive and Social Medicine, 21st edition, page27.
Quizzes
Targeted intervention programmes for HIV are done among the following group of
people, EXCEPT:
A: Commercial sex worker

B: Migrant laborers
C: Street children
D: Industrial worker
Correct Ans:D
Explanation
The basic purpose of the targeted interventions for HIV is to reduce the rate of
transmission of HIV among the most vulnerable population such as,
Sex workers
Intravenous drug users
Homosexual men
Truckers
Migrant laborers
Street children
The main activities under these intervention projects are behaviour change,
communication, treatment for STDs and creating an enabling environment that will
facilitate behaviour change.

Ref: Park’s Textbook of Preventive and Social Medicine, 19th edition, Page 359.
Quizzes
As per WHO 2010 guidelines, when should an HIV infected adult be started on anti
retroviral therapy?
A: CD4 count less than 600 irrespective of staging
B: CD4 count less than 350 irrespective of staging
C: CD4 count less than 500 irrespective of staging
D: CD4 count less than 450 irrespective of staging

Correct Ans:B
Explanation
Target population 2010 ART guideline 2006 ART guideline
HIV+
asymptomatic
ARVnaive
individuals
CD4 ≤350 cells/mm3 CD4 ≤200 cells/mm3
HIV+
symptomatic
ARVnaive
individuals
WHO clinical stage 2 if CD4 ≤350
cells/mm3
OR
WHO clinical stage 3 or 4
irrespective of CD4 cell count
WHO stage 2 or 3 and CD4
≤200 cells/mm3
WHO stage 3 if CD4
not available
WHO stage 4 irrespective of
CD4 cell count
Consider treatment for
WHO
clinical stage 3 and CD4 cell
count between 200 and 350
cells/mm3
HIV+ pregnant
women
CD4 ≤350 cells/mm3 irrespective of
clinical symptoms OR
WHO clinical stage 3 or 4 irrespective
of CD4 cell count
WHO stage 1 or 2 and CD4
≤200 cells/mm3
WHO stage 3 and CD4 ≤350
cells/ mm3
WHO stage 4 irrespective of
CD4 count

Ref: Epidemiology of communicable diseases
Park’s textbook of Preventive and Social Medicine, 21stedition, page327.
Quizzes
You are asked to help consult on a study which was recently completed in coastal African
country. In this study, a total of 274 soldiers stationed in three different camps were
examined and tested for the presence of bacterial sexually transmitted diseases (STD)
and human immunodeficiency virus (HIV) positivity. In addition to the information from
the clinical exam and laboratory specimens, interviews were conducted to gather
information on age, years of military service, ethnicity, and region of origin. The data are
now to be analyzed to learn which factors were associated with the presence of STDs,
including HIV. What is the most accurate description of this study design?
A: A casecontrol study

B: A cohort study
C: A clinical trial
D: A crosssectional study
Correct Ans:D
Explanation
In a crosssectional study, a variety of independent variables can be studied for their
association with the outcome variables. In this example, the independent variables would
include age, years of military service, ethnicity, and region of origin. The outcome
variables include the presence of bacterial sexually transmitted diseases (STDs) and HIV
positivity. This study does not meet the criteria for being a casecontrol, cohort, or case
cohort study, nor is it a clinical trial. The crosssectional study is limited in its power, and
valid inferences may be especially difficult to make from crosssectional studies, even
when statistically significant associations are observed.
Quizzes
HIV sentinel surveillance is used to calculate:
A: Detection of high risk group
B: Prevalence
C: Monitoring disease trend
D: Detection of incidence
Correct Ans:C
Explanation
HIV sentinel surveillance used to calculate Trend finding

HIV sentinel surveillance (HSS) in India
HIV sentinel surveillance (HSS) in India, since its inception in 1998, has evolved
into a credible and robust system for HIV epidemic monitoring and acclaimed as
one of the best in the world.
Sentinel surveillance provides essential information to understand the trends and
dynamics of HIV epidemic among different risk groups in the country
It aids in refinement of strategies and prioritization of focus for prevention, care
and treatment intervention under the National AIDS Control Programme (NACP)
HIV estimates of prevalence, incidence and mortality developed based on findings
from HIV Sentinel Surveillance enable the programme in assessing the impacts the
impacts at a macro level.
Ref: Park 22nd ed/ 400.
Quizzes

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