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Question 1
Incorrect
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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: Gentamicin
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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This question is part of the following fields:
- HIV
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Question 2
Incorrect
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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 commence cART if viral load >100 000 copies/ml
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.
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This question is part of the following fields:
- HIV
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Question 3
Incorrect
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Which of the following immunological components is deficient in a 5-year-old HIV positive child who develops Pneumocystis jiroveci pneumonia?
Your Answer: IgM
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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This question is part of the following fields:
- HIV
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Question 4
Incorrect
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A 12-month-old baby with HIV is scheduled for his MMR vaccine. What is the most appropriate action?
Your Answer: Give half dose of vaccine
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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This question is part of the following fields:
- HIV
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Question 5
Incorrect
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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: Emtricitabine
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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This question is part of the following fields:
- HIV
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Question 6
Incorrect
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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: Await the CD4 count and percentage to decide on the need for co-trimoxazole and antiretroviral therapy
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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This question is part of the following fields:
- HIV
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Question 7
Incorrect
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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: Efavirenz
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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This question is part of the following fields:
- HIV
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Question 8
Incorrect
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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: Low birth weight
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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This question is part of the following fields:
- HIV
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Question 9
Incorrect
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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 protease
Correct 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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This question is part of the following fields:
- HIV
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Question 10
Incorrect
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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: Gonococcal conjunctivitis
Correct 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/μL, 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.
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This question is part of the following fields:
- HIV
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SESSION STATS - PERFORMANCE PER SPECIALTY
