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Question 1
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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.
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This question is part of the following fields:
- HIV
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Question 2
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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: 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 3
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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 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 4
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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: 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 5
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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: 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 6
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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: 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 7
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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.
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This question is part of the following fields:
- HIV
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Question 8
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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: 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
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Question 10
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Which of the following is true of mother to child transmission in the case of a mother with HIV infection?
Your 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.
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This question is part of the following fields:
- HIV
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SESSION STATS - PERFORMANCE PER SPECIALTY
