We would appreciate it if you would answer the first three questions.
However, if you choose not to tell us your e-mail address and you are a
health care provider, we would appreciate it if you would at least tell
us the number of HIV seropositive patients you care for. This will help
us to correlate exam scores with the experience of the provider. Thank
You.
Are you a health care provider? NoYes
If you do provide health care, how would you describe yourself professionally?
If you provide health care, how many HIV-infected patients do you care for? None 1-10 11-50 51 or more
Your E-mail Address(Optional)
Please answer every question. There is only one correct answer for
each question. You will see the correct answers and receive your score
after you have answered all of the questions.
1. Most patients in late-stage HIV infection develop toxoplasmosis
from which of the following? New infection following exposure
to cat stool
New infection following exposure
to undercooked meat
New infection from exposure
to a patient with toxoplasmosis
New infection from contaminated
water
Activation of latent infection
2. The RT 184 mutation is associated with high rates of resistance
to? 3TC
AZT
Nevirapine
d4T
Abacavir
3. A patient sees you complaining of a sore mouth for 2 days. There
is a history of genital herpes, pneumococcal pneumonia, "shingles," oral
hairy leukoplakia and a positive PPD. The CD4 count is 205/mm3 and current
medications include nevirapine, nelfinavir, ddI, hydroxyurea, trimethoprim-sulfamethoxazole,
and sertraline (Zoloft). Oral exam is shown in the figure. A Tzanck prep
of the lesion is negative. Which of the following is most likely to provide
relief? Acyclovir therapy
Thalidomide therapy
Discontinue nevirapine
Discontinue trimethoprim-sulfamethoxazole
Discontinue nelfinavir
4. The most important component of the lipid profile for atherogenesis is which of the following? triglyceride level of 400 mg/dL
total cholesterol of 286 mg/dL
LDL cholesterol of 140 mg/dL
HDL cholesterol of 100 mg/dL
fasting blood glucose of 128 mg/dL
5. Which of the following drugs have been associated with hypertriglyceridemia? Ritonavir
Hydroxyurea
Delavirdine
Abacavir
Stavudine (d4T)
6. the risk of which of the following HIV-associated complications is the least
reduced by immune reconstitution with HAART? Kaposis sarcoma
HIV-associated dementia
Non-Hodgkins lymphoma
Thrush
Pneumococal pneumonia
7. Human herpes virus 8 has been most convincingly implicated in
which of the following: Hepatocellular carcinoma
CNS lymphoma
Castleman's disease
Acute myelocytic leukemia
Hypernephroma
8. Which of the following drugs shows the best penetration across
the blood-brain barrier? Retrovir (AZT)
Stavudine (d4T)
Lamivudine (3TC)
Didanosine (ddI)
Zalcitabine (ddC)
9. A 32-year-old drug user is seen in an emergency department with
abdominal pain and fever. He has known HIV infection and a recent CD4 count
was 10/mm3. He reports that he has had intermittent diarrhea with 2 to
6 loose stools daily for about 2 weeks, and then noted nausea, vomiting,
and right upper quadrant abdominal pain. Physical exam shows a temperature
of 38.5 C (101.3 F) and right upper quadrant tenderness. Medications include
AZT, ddI, TMP- SMX, fluconazole, acyclovir, and megavitamins. Laboratory tests show the following: Hematocrit: 29% WBC: 3200 (72% PMNs, 8% bands, 10% lymphs, 5% monocytes, and 5%
eosinophils) Platelet count: 88,000/mm3 Bilirubin: 1.4 mg/dL, AST: 121 U/L, ALT: 135 U/L Alkaline phosphatase: 860 U/L Chest x-ray: Negative Abdominal flat plate: Negative Ultrasound of abdomen: Dilated biliary ducts without stones Stool ova and parasite exam with AFB stain: Negative
The most likely cause is: An adverse drug reaction
Cryptosporidia
Cyclospora
Entamoeba histolytica
Mycobacterium avium
10. Which of the following is NOT detected with AFB stain of stool
in patients with diarrhea? Cryptosporidia parvum
Cyclospora cayetanensis
Isospora belli
Microsporidia
Septata intestinalis
11. A 30-year-old man with HIV infection with a CD4 count of 680/mm3
is referred for evaluation of refractory sinusitis. He reports headaches,
purulent nasal drainage and nasal stuffiness for 2 weeks. There has been
no documented fever. Prior treatment consisted of amoxicillin x 5 days,
then TMP-SMX, one DS bid x 3 days; epinephrine nasal spray and ibuprofen
has been given for 2 to 3 weeks. Diagnostic studies included the following: CT scan--bilateral air fluid levels in maxillary sinuses Nasal drainage--PMNs and eosinophils Culture--moderate S. aureus sensitive to methicillin WBC--7,800 with 62% PMNs, 4% bands, 20% lymphocytes, 9% monocytes,
5% eosinophils. The treatment that is likely to be most effective is: Dicloxacillin
Neo-Synephrine nasal spray
Cortisone nasal spray
Ipratropium bromide nasal spray
Cough syrup containing dextromethorphan.
12. A pregnant woman has a CD4 count of 550/mm3 and viral load of 860 c/ml with no antiretroviral therapy. Which of the following has demonstrated benefit in preventing perinatal transmission in this setting? AZT monotherapy
Nevirapine
HAART
C-section
None of the above
13. Which of the following conditions is not seen in an immunocompetent
host? Toxoplasma encephalitis
Cryptosporidiosis
Cryptococal meningitis
Kaposi's sarcoma
Perirectal herpes
14. A 30-year-old woman presents with watery diarrhea with 6-8 stools/day
for nearly 2 months. She is discovered to have HIV infection with a CD4
count of 22/mm3. A stool AFB smear is shown. Which of the following treatments
is most likely to eradicate the pathogen? Paromomycin
Trimethoprim-sulfamethoxazole
Albendazole
Nitrazoxanide
Highly active antiretroviral
therapy (HAART)
15. All of the following are poor prognostic factors in Cryptococcal
meningitis except: Cerebrospinal fluid (CSF) leukocytosis
Serum of CSF cryptococcal antigen
titer >1:32
Elevated CSF opening pressure
Altered mental status
Low CSF glucose
16. Which of the following is true about hepatitis C (HCV) infection? More than 50% of patients have genotype 1
More than 50% of patients eventually die of complications
of HCV if untreated
More than 50% of patients are cured (have elimination of HCV
with treatment with interferon + ribavirin for 6-12 months
More than 50% get cirrhosis within 20 years
More then 50% with acute HCV infection will spontaneously
clear the HCV infection
17. The diagnosis of progressive multifocal leukoencephalopathy
is supported by which of the following findings? Cerebrospinal fluid pleocytosis
Cerebrospinal fluid elevated
protein
Fever
Rapid onset of symptoms
Brain biopsy with positive
stain for SV-40 virus
18. Which of the following drugs is least likely to cause lactic acidosis? AZT
3TC
ddC
ddI
Tenofovir
19. A lymph node biopsy from an HIV-positive patient currently residing
in the state prison is submitted to the laboratory for acid-fast smear
and culture. The acid-fast smear is reported as positive. Acid-fast organisms
are recovered on solid medium after 3 days of incubation. This organism
is likely to be: Mycobacterium xenopi
Mycobacterium kansasii
Mycobacterium fortuitum
Mycobacterium tuberculosis
Mycobacterium avium
20. A 30-year-old man has been treated with AZT, 3TC, ritonavir, and indinavir for three years. His CD4 count increased from 230 to 550/mm3 with VL<50 c/ml for over two years. He decides to stop therapy. When should HIV become detectable? One week
Two weeks
Four weeks
Eight weeks
Three months
21. The most common current mechanism of transmitting hepatitis
C virus is: Sexual intercourse
Transfusions
Needle sharing by injection
drug users
Perinatal transmission
Ingestion of contaminated food
22. Which of the following decreases blood levels of indinavir? Delavirdine
Efavirenz
Nelfinavir
d4T
Ketoconazole
23. Which of the following drugs is most likely to increase the fasting blood glucose? Tenofovir
Hydroxyurea
Nevirapine
Indinavir
IL-2
24.Food should be given with: Amprenavir
Indinavir
AZT
Nevirapine
Lopinavir
25. Which of the following is the best predictor of long-term prognosis in patients
with hepatitis C infection? ALT levels
HCV-RNA PCR levels
Genotype
Liver biopsy
Sedimentation rate
26. A 37-year-old man with AIDS is receiving AZT, ddI and nelfinavir.
He has done well with a viral burden that decreased from 88,000 copies/dL
to undetectable. At his last clinic visit he is noted to have a CBC showing
an absolute neutrophil count of 400/mm3; neutropenia is confirmed. A review
of prior CBCs shows all had ANC values >1800/mm3. The preferred regimen
for this patient among the options given is: ddI, d4T, and saquinavir (Fortovase)
d4T, ddI and nelfinavir
3TC, ddI and indinavir
ddC, ddI and ritonavir
ddI, ritonavir and saquinavir
27. A 40-year-old school teacher with HIV infection and a CD4 count
of 360/mm3 is taking INH due to a positive PPD skin test. After one month
of treatment the ALT increased from 30 IU/dL at baseline to 90 IU/dL. The
upper limit of normal is 35 IU/dL. The patient is asymptomatic. What treatment
should be given? Continue INH in same dose
Discontinue prophylaxis
Substitute rifampin
Substitute rifampin + ethambutol
Biopsy the liver and then continue
INH if there is no evidence of drug-induced hepatitis
28. For the average patient, which of the following treatments gives
the longest delay in relapse of CMV retinitis? IV ganciclovir
IV foscarnet
IV cidofovir
Ganciclovir implant
Oral ganciclovir
29. A 40 year old man has suspected pneumococcal pneumonia.
He takes MAC prophylaxis with weekly azithromycin and receives PCP prophylaxis
with TMP-SMX. The antibiotic most likely to be active in vitro against
his strain of S. pneumoniae is: Erythromycin
Cefuroxime
Cefotaxime
Levofloxacin
Clindamycin
