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  • Question 1 - Which of the following is true of mother to child transmission in the...

    Incorrect

    • Which of the following is true of mother to child transmission in the case of a mother with HIV infection?

      Your Answer: HIV positive mothers established on combination ART should be encouraged to breastfeed

      Correct Answer: The risk of HIV vertical transmission is increased by concurrent maternal Hepatitis C infection

      Explanation:

      To prevent mother to child transmission in the case of an HIV infected mother, guidelines have been put in place in the that guide practices. During pregnancy the risk of intrauterine transmission is quite low, as is the risk of transmission during vaginal delivery. As a result the number of women that choose to have caesarean sections have fallen, with vaginal births increasing by 40%. One factor that can however increase the risk of mother to child HIV transmission is concurrent Hepatitis C infection which double the risk of vertical transmission.

    • This question is part of the following fields:

      • HIV
      38.5
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  • Question 2 - A 10-year-old boy presents with bilaterally enlarged parotid glands for more than 9...

    Correct

    • A 10-year-old boy presents with bilaterally enlarged parotid glands for more than 9 months. On examination, both parotid glands are firm and non-tender and are not warm to touch.What is the most probable infectious cause for chronic parotitis in the given scenario?

      Your Answer: Human immunodeficiency virus (HIV)

      Explanation:

      The most probable cause for chronic parotitis in this patient would be HIV infection.Rationale:Chronic infectious parotitis is relatively uncommon in children. While mycobacterial infection can result in chronic parotitis, HIV is a relatively more common cause. The presentation should always prompt an HIV test. Other options:- While mumps is the most common cause of acute viral parotitis, the chronic nature of the boy’s presentation rules it out. – Acute bacterial parotitis is usually unilateral and is warm and tender to touch.

    • This question is part of the following fields:

      • HIV
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  • Question 3 - A 10-month-old girl is brought to the hospital by her mother. The family...

    Incorrect

    • A 10-month-old girl is brought to the hospital by her mother. The family moved to the UK three months ago from The Congo. The baby's mother explains that she is HIV positive and took combination antiretrovirals throughout her pregnancy. She was unable to attend follow-up for her baby as the family was displaced. The baby was breastfed until the age of six months and is thriving. A physical examination revealed no significant findings.What would be the most appropriate action concerning the baby's HIV exposure?

      Your Answer: Perform HIV PCR and CD4 count and commence cART and PJP prophylaxis if CD4 <500 cells/µl

      Correct Answer: Perform HIV PCR and commence cART and PCP prophylaxis if HIV positive

      Explanation:

      The most appropriate action in this baby would be to perform HIV PCR and commence cART and PCP prophylaxis if HIV positive.Treatment guidelines for HIV-positive infants state that all should receive combination antiretroviral therapy (cART) and Pneumocystis jiroveci pneumonia (PJP) prophylaxis, irrespective of CD4 count or viral load.

    • This question is part of the following fields:

      • HIV
      30.7
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  • Question 4 - A 16-year-old visibly anxious female, known to have HIV, presents to the clinic...

    Correct

    • A 16-year-old visibly anxious female, known to have HIV, presents to the clinic with blurring of vision and blind spots in her field of vision. Her last CD4 count was reported to be 45 cells/mL. Which of the following complications of HIV has most likely occurred that has resulted in her ocular damage?

      Your Answer: Cytomegalovirus (CMV) retinitis

      Explanation:

      The most common etiological agent for retinitis in HIV infected patients is cytomegalovirus (88.63% of retinitis in HIV/AIDS patients). Most patients have a CD4 lymphocyte count less than 50/ÎĽL, which can represent the susceptibility to this type of retinitis when lymphocyte count falls below this threshold. The treatment consists of systemic intravenous administration of Ganciclovir or Foscarnet at a first stage of induction, followed by the maintenance treatment with oral administration of Ganciclovir.

    • This question is part of the following fields:

      • HIV
      16.7
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  • Question 5 - A 12-month-old baby with HIV is scheduled for his MMR vaccine. What is...

    Correct

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

      Your Answer: Don't give the vaccine

      Explanation:

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

    • This question is part of the following fields:

      • HIV
      16.8
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  • Question 6 - The mother of 6 months old girl tests positive for HIV. Doctors test...

    Incorrect

    • 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 and antiretroviral therapy immediately

      Correct 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 7 - A 15-year-old girl known with HIV develops lipoatrophy over her thighs and abdomen....

    Correct

    • 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: 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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      • HIV
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  • Question 8 - An 18-year-old male presents to his family physician after a sexual encounter with...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • HIV
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  • Question 9 - A 13-year-old girl takes a deliberate, unknown number of paracetamol tablets in one...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • HIV
      21.1
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  • Question 10 - Which of the following immunological components is deficient in a 5-year-old HIV positive...

    Correct

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

      Your 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.

    • This question is part of the following fields:

      • HIV
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  • Question 11 - A 14-year-old girl with HIV develops jaundice while being treated for overwhelming sepsis....

    Incorrect

    • A 14-year-old girl with HIV develops jaundice while being treated for overwhelming sepsis. Blood investigations reveal:ALT: 50 IU/L (0-45) Alkaline phosphatase (ALP): 505 IU/L (0-105)Which of the following medications has she most likely been administered in the course of her treatment?

      Your Answer: Vancomycin

      Correct Answer: Co-amoxiclav

      Explanation:

      Based on the presentation, she probably was administered co-amoxiclav.The liver function tests are highly suggestive of cholestatic jaundice, which is a classic adverse dug reaction related to co-amoxiclav use.Other options:- Erythromycin is more commonly associated with gastrointestinal (GI) disturbance.- Gentamicin is more commonly associated with renal impairment.- Meropenem does not commonly cause cholestasis but is associated with transaminitis.- Vancomycin is associated with red man syndrome on fast administration.

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      • HIV
      17.6
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  • Question 12 - A 19-year-old male newly diagnosed with HIV is initiated on highly active antiretroviral...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • HIV
      14.7
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  • Question 13 - 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.

    • This question is part of the following fields:

      • HIV
      13.1
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  • Question 14 - 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)

    • This question is part of the following fields:

      • HIV
      16.8
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  • Question 15 - A new-born delivered at term with a birth weight of 2.5kgs was admitted...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • HIV
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HIV (11/15) 73%
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