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  • Question 1 - A 16-year-old male is learning about HIV as part of sex and relationships...

    Correct

    • A 16-year-old male is learning about HIV as part of sex and relationships education in school. What is the most common mode of transmission of HIV?

      Your Answer: Unprotected anal or vaginal sexual intercourse with an infected individual

      Explanation:

      Unprotected anal or vaginal sexual intercourse with an infected individual is by far the most common (95%) route by which HIV is transmitted. Other options:- Blood transfusion is an extremely rare cause of HIV transmission in the UK. – While HIV can be transmitted from mother to baby either during birth or via breastfeeding, the transmission rate is only 5 -20%.- Sharing contaminated needles does put individuals at risk of getting HIV, although public health measures are in place to reduce this risk. – Although HIV can be transmitted via this route, it is around ten times less likely to result in transmission than unprotected anal or vaginal intercourse with an infected individual.

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      • HIV
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  • Question 2 - An 18-year-old homosexual male presents 36 hours after having unprotected sex with his...

    Correct

    • An 18-year-old homosexual male presents 36 hours after having unprotected sex with his partner whose HIV status is not known. He is concerned about his risk of acquiring HIV. He is feeling well and shows no symptoms. The physician offers him a post exposure prophylaxis, which consists of 3 different antiviral drugs. Two of these drugs act by which of the following mechanisms?

      Your Answer: Inhibition of viral reverse transcriptase

      Explanation:

      Recommended regimens3 NRTI (e.g., zidovudine, lamivudine, abacavir) OR2 NRTI (e.g., lamivudine + abacavir) AND1 NNRTI (e.g., efavirenz) OR1 PI (e.g., lopinavir) OR1 INI (e.g., raltegravir)

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      • HIV
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  • Question 3 - The mother of 6 months old girl tests positive for HIV. Doctors test...

    Correct

    • The mother of 6 months old girl tests positive for HIV. Doctors test her daughter as well and the results turn out to be positive for HIV, both by polymerase chain reaction (PCR) and serology. The girl is clinically healthy and seems to attain normal developmental milestones. Which of the following is the most appropriate next step?

      Your Answer: Start co-trimoxazole prophylaxis immediately and plan to start antiretrovirals once further work-up is complete

      Explanation:

      Infants exposed to maternal HIV and with positive results require immediate management with co-trimoxazole prophylaxis, regardless of their CD4 levels. Antiretroviral treatment is necessary as well but it could wait until further work-up is complete.

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      • HIV
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  • Question 4 - A 12-month-old baby with HIV is scheduled for his MMR vaccine. What is...

    Incorrect

    • A 12-month-old baby with HIV is scheduled for his MMR vaccine. What is the most appropriate action?

      Your Answer:

      Correct Answer: Don't give the vaccine

      Explanation:

      Live attenuated vaccines such as the MMR, should be avoided in HIV+ patients.

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      • HIV
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  • Question 5 - A 13-year-old girl takes a deliberate, unknown number of paracetamol tablets in one...

    Incorrect

    • A 13-year-old girl takes a deliberate, unknown number of paracetamol tablets in one go. She immediately regrets her actions and calls for help. She was brought to the hospital 2 hours after consuming the tablets. She has a history of HIV and is on antiretroviral therapy, though she cannot recall the name of the medication. Which of the following management options is most appropriate for this patient?

      Your Answer:

      Correct Answer: Check paracetamol level in further 2 hours' time

      Explanation:

      According to the Rumack-Matthew Normogram, accurate levels of paracetamol can be measured only between 4-15 hours. The levels measured before 4 hours post-ingestion would highly underestimate the level of paracetamol ingested.The patient in question presents 2 hours after ingestion. Hence the most appropriate time to measure the levels of acetaminophen would be a further 2 hours later. Other options:- Note that the treatment with NAC can be delayed until the 4-hour level is obtained and compared to the nomogram.- Furthermore, haemodialysis is only indicated if she develops hepato-renal syndrome that is likely to occur 72-96 hours post-ingestion.- Indications for acute liver transplantation include persistent acidosis, hepatorenal syndrome and worsening coagulopathy.

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  • Question 6 - An 18-year-old male presents to his family physician after a sexual encounter with...

    Incorrect

    • An 18-year-old male presents to his family physician after a sexual encounter with his new girlfriend during which they had sexual intercourse around ten days ago. The girlfriend's HIV status is unknown, and the patient is concerned that he might have acquired HIV. He has a blood test for a 4th generation assay, testing for HIV antibody and a p24 antigen. The results come out negative, however, HIV infection cannot be ruled out as he may be presenting in the window period. Which of the following most likely explains the pathology of the window period?

      Your Answer:

      Correct Answer: Antibodies to HIV undetectable

      Explanation:

      Any blood test used to detect HIV infection must have a high degree of sensitivity (the probability that the test will be positive if the patient is infected) and specificity (the probability that the test will be negative if the patient is uninfected). Unfortunately, no antibody test is ever 100 % sensitive and specific. Therefore, if available, all positive test results should be confirmed by retesting, preferably by a different test method. HIV antibody tests usually become positive within 3 months of the individual being infected with the virus (the window period). In some individuals, the test may not be positive until 6 months or longer (considered unusual). In some countries, home testing kits are available. These tests are not very reliable, and support such as pre and post test counselling is not available.

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  • Question 7 - A new-born delivered at term with a birth weight of 2.5kgs was admitted...

    Incorrect

    • A new-born delivered at term with a birth weight of 2.5kgs was admitted to the NICU with suspected congenital TB. Her mother is HIV positive and is on HAART, recently diagnosed with tuberculosis 1 week ago. All of the following are features of congenital tuberculosis EXCEPT?

      Your Answer:

      Correct Answer: Diarrhoea

      Explanation:

      Congenital TB symptoms typically develop during the second or third week of life and include poor feeding, poor weight gain, cough, lethargy, and irritability. Other symptoms include fever, ear discharge, and skin lesions.Signs of congenital TB include failure to thrive, icterus, hepatosplenomegaly, tachypnoea, and lymphadenopathy.

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  • Question 8 - A 15-year-old girl known with HIV develops lipoatrophy over her thighs and abdomen....

    Incorrect

    • A 15-year-old girl known with HIV develops lipoatrophy over her thighs and abdomen. Which of the following medications can cause this side effect?

      Your Answer:

      Correct Answer: Zidovudine

      Explanation:

      Among the options provided, zidovudine causes lipoatrophy as a side effect.Zidovudine: Although both hypertrophy and atrophy are described related to HIV medications, nucleoside reverse transcriptase inhibitor (NRTIs) such as zidovudine and stavudine are closely associated with fat loss.Other options:- Enfuvirtide is an HIV-fusion inhibitor. Lipoatrophy is not commonly associated with this drug.- Efavirenz is an NNRTI, which is not associated with lipoatrophy. Common side effects include neuropsychiatric effects, rash and nausea. – Ganciclovir is not an anti-HIV medication and is used for cytomegalovirus (CMV) infections.- Raltegravir is an integrase inhibitor and is associated with fat gain.

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  • Question 9 - Which of the following immunological components is deficient in a 5-year-old HIV positive...

    Incorrect

    • Which of the following immunological components is deficient in a 5-year-old HIV positive child who develops Pneumocystis jiroveci pneumonia?

      Your Answer:

      Correct Answer: T cells

      Explanation:

      Patients with HIV have a deficiency of CD4 lymphocytes which are also known as helper T cells (Th). They are involved with antigen-specific responses as well as delayed-type hypersensitivity. The risk of developing P. jiroveci pneumonia is greatest with a CD4 count of 200 x 109/l or below.

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      • HIV
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  • Question 10 - A 19-year-old male newly diagnosed with HIV is initiated on highly active antiretroviral...

    Incorrect

    • A 19-year-old male newly diagnosed with HIV is initiated on highly active antiretroviral therapy (HAART). He was previously well and had no past medical or psychiatric history. A few days after starting the medication, he develops poor sleep and nightmares, with low mood and suicidal ideation. Which antiretroviral agent is most probably responsible for the side effects mentioned?

      Your Answer:

      Correct Answer: Efavirenz

      Explanation:

      The antiretroviral agent for the side effects mentioned is most probably, efavirenz.Efavirenz is a non-nucleoside reverse transcriptase inhibitor and the most likely cause of new-onset psychiatric symptoms in someone taking HAART. In this scenario the patient had no pre-existing mental health problems, as other antiretrovirals can cause depression and suicidal ideation in those who have a past psychiatric history. Symptoms usually subside after a few weeks of treatment.Other options:- Emtricitabine is a nucleoside reverse transcriptase inhibitor and is also not known to cause psychiatric side effects. The most common side effects of Emtricitabine are rash and darkening of the palms or soles.- Lamivudine is a nucleoside reverse transcriptase inhibitor, which can cause insomnia, but does not commonly cause other psychiatric symptoms.- Rilpivirine is a non-nucleoside reverse transcriptase inhibitor, which can cause depression. However, this is more common in those with a history of mental health problems.- Tenofovir is a nucleotide reverse transcriptase inhibitor. The most common side effect of Tenofovir is gastrointestinal upset. It is not known to cause psychiatric side effects.

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      • HIV
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