Johns Hopkins HIV/AIDS Specialty Test

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. A 40-year-old man with HIV infection complains of headache, fever, and blurred vision. He takes AZT, 3TC, nelfinavir, dapsone, and INH. Exam shows thrush and perirectal vesicles. A CD4 count is 86/mm3 and a head MRI is negative. The most likely diagnosis of his CNS infection is:
T. pallidum
Toxoplasma gondii
Cryptococcus
Progressive multifocal leukoencephalopathy
H. simplex

2. A 32-year-old woman with HIV infection complains of intermittent diarrhea without fever for 30 days and fatigue. She takes d4T, 3TC, nevirapine, dapsone, and fluconazole. A CD4 count is 70/mm3. The single most likely diagnosis is infection due to:
Giardia
E. histolytica
C. difficile
Salmonella
Cryptosporidia

3. Which of the following drugs is most likely to cause high level resistance within weeks of therapy when used as monotherapy?
AZT
3TC
ddI
ddC
Abacavir

4. Which of the following microbes poses a potential threat of transmission from a patient source with HIV infection to a healthy health care worker without HIV infection?
M. avium complex
Cryptosporidia
Histoplasmosis
Microsporidia
Cryptococcosis

5. Which of the following vaccines is contraindicated in patients with AIDS and a CD4 count < 200/mm3?
Tetanus
N. meningitidisB>
Diphtheria
Rabies
Smallpox

6. A 40-year-old gay man with HIV infection complains of intermittent crampy abdominal pain and diarrhea for 2 months. The major concern is 1-3 loose stools daily accompanied by bloating. He took AZT, ddI, and indinavir, but discontinued this when he noted the abdominal symptoms. Nevertheless, there was no improvement. He has been well otherwise and afebrile. He has a CD4 count of 350/mm3. The most likely diagnosis is:
Salmonellosis
C. difficile colitis
Microsporidia
Irritable bowel syndrome
Kaposi's sarcoma of the gut

7. Which of the following does not promote higher levels of saquinavir?
Grapefruit juice
Ritonavir
Ketoconazole
Delavirdine
Nevirapine

8. Which of the following drugs has been associated with serious hypersensitivity reactions characterized by fever, GI distress, and rash?
Efavirenz
Hydroxyurea
Abacavir
Saquinavir (Invirase formulation)
Nelfinavir

9. The opportunistic organism most likely to infect the adrenal gland in patients with advanced HIV infection is:
M. avium
Histoplasma capsulatum
Candida albicans
CMV
Cryptococcus neoformans

10. Which of the following is true about testing of HIV strains for resistance to antiretrovial agents?
Most studies of treatment naive patients show at least one major mutation associated with resistance to one of the three classes of drus currently available.
A single mutation may confer high level resistance to all currently available protease inhibitors, e.g. class resistance.
A single mutation may confer high level resistance to all currently available NNRTI's.
Treatment-experienced patients should be tested after antiretroviral therapy has been discontinued.
The most common cause of failure to achieve no detectable virus after 12 weeks on HAART with a PI is resistance to the PI.

11. Which of the following drugs is most likely to cause C. difficile associated colitis?
Trimethoprim-sulfamethoxazole
Dapsone
Ciprofloxacin
Erythromycin
Amoxicillin

12. Which of the following are most likely to have G6PD deficiency?
African-American men
African-American women
Hispanic men
Hispanic women
Caucasian women

13. Which of the following is most likely to show no white blood cells in cerebrospinal fluid?
Toxoplasma encephalitis
CNS lymphoma
Progressive multifocal leukoencephalopathy
Neurosyphilis
CMV encephalitis

14. A patient with HIV infection is receiving no medications and is seen for routine follow-up. At the previous visit 6 months ago, the CD4 count was 860/mm3 and the CD4 percentage was 46%. The viral burden at that time was 562 copies/ml. At this visit the CD4 count is 620/mm3 and the CD4 percentage is 40%. The viral burden is undetectable (less than 400 copies/ml). Which of the following would be most appropriate?
Repeat the CD4-cell count in the same lab
Repeat the CD4-cell count, but use a different lab
Request a complete T-subset analysis
Obtain additional studies for HIV staging including B2 microglobulin and neopterin
Do nothing and see the patient in 3 months

15. A patient sees you because she was told that her blood was rejected by the Red Cross due to an indeterminate HIV result 3 months ago. She denies risks except for heterosexual sex with two male partners during the last 6 months. She has been generally healthy during the past year. Serologic testing at this time is likely to show:
HIV infection
HTLV-1 infection
HIV-2 infection
HTLV-2 infection
No evidence of retroviral infection

16. A 25-year-old man with advanced HIV infection is hospitalized with fever and diarrhea of 2-3 weeks duration. He has been treated with ddI, ritonavir, saquinavir, and trimethoprim-sulfamethoxazole. Exam shows thrush, wasting, and KS lesions on the face and arms. Admission laboratory studies show:


Hematocrit of 28%, WBC 3,100/mm3;
CD4 count of 2/mm3;
ALT of 56 IU/L, alkaline phosphatase of 211 IU/L, amylase of 53 IU/L, a potassium of 3.1 MEQ/L, and an albumin of 2.3 gm/dL;
Chest x-ray is negative;
Blood culture at 48 hours yields S. epidermidis;
Stool C. difficile toxin assay is negative, stool culture is negative,
Stool O&P exam shows Blastocystis hominis.


Treatment directed against which organism is most likely to produce defervescence?
S. epidermidis
Microsporidia
Blastocystis hominis
Cryptosporidia
M. avium complex

17. Lab tests in a patient receiving d4T, ddI, indinavir, and ritonavir show an LDL cholesterol of 200 mg/dL and triglyceride of 200 mg/dL. Which drug is preferred?
Lovastatin
Pravastatin
Fluvastatin
Gemfibozil
Fenofibrate

18. Which of the following clades is most common in the world?
A
B
C
D
E

19. A 27-year-old gay man has negative HIV serology but continues to practice high risk behavior. He requests assurance that he does not have HIV infection. The most sensitive blood test to provide this assurance is:
p24 antigen
Routine serologic test
HIV DNA assay
HIV RNA level
HIV culture

20. The most common side-effect of nelfinavir is:
Epigastric pain
Diarrhea
Headache
Nephrolithiasis
Neuropathy

21. A 32-year-old man with AIDS consults for fever, a rash of 3-5 days duration and painful feet of two weeks duration. He had PCP eight months previously and has subsequently received AZT, ddI, saquinavir, ketoconazole (200 mg/day), trimethoprim-sulfamethoxazole (1 DS/day), and vitamin C (1 gm daily). He was seen for a routine visit three weeks ago and was asymptomatic with a negative physical exam and the following laboratory tests:


WBC 2,100/mm3 (75% PMN's, 4% bands, 13% lymphs, 8% monocytes);
Hematocrit 32%, platelet count of 80,000/mm3;
AST 38 IU/L.


Physical exam now shows a maculopapular rash, a supple neck and fever of 38.8C.


Laboratory studies now show:
WBC 1,200 (45% PMS's, 7% bands, 32% lymphocytes, 16% monocytes);
Hematocrit 26%;
Platelet count 62,000/mm3,
AST 462 IU/L, alkaline phosphatase of 210 IU/L.


Which of the following drugs is an unlikely cause of an adverse drug reaction in this patient?
AZT
Trimethoprim-sulfamethoxazole
Ketoconazole
ddI
Vitamin C

22. Albendazole is effective therapy for most patients infected by:
Toxoplasma gondii
Enterocytozoon bienusi
Septata intestinalis
Cryptosporidia
Cyclospora

23. Which of the following codon mutations on the RT gene confers resistance to AZT, ddI, ddC d4T, 3TC and abacavir?
41
70
151
215
219

24. The average efficiency of HIV transmission with a single episode of unprotected receptive vaginal intercourse with an untreated HIV infected source is approximately?
30%
3%
0.3%
0.03%
0.003%

25. A 30-year old woman with HIV infection and a CD4 count of 180/mm3 has a platelet count of 40,000/mm3. She reports mild gum bleeding while brushing teeth, but denies other forms of bleeding and has not noted bruising. Her platelet count 3 months ago was 65,000/mm3. Medications do not appear to be the cause of her thrombocytopenia. What treatment is appropriate at this time?
IVIG
Prednisone
Splenic irradiation
Danazol
No treatment

26. Fecal leukocytes are most likely with diarrhea due to:
Mycobacterium
Septata intestinalis
Cryptosporidium
Isospora
Cytomegalovirus

27. A 30-year-old man has been taking d4T, 3TC, indinavir, and ritonavir for three years. He is disturbed by his change in facial appearance, which shows loss of buccal fat. Which of the following is most likely to be successful therapy?
Change d4T to AZT
Change 3TC to ddI
Change indinavir/ritonavir to efavirenz
Give growth hormone
Cosmetic surgery


28. Which of the following drugs is recommended for AIDS patients with bacillary angiomatosis?
Penicillin
Ciprofloxacin
Erythromycin
Cephalosporin
Vancomycin


29. Which of the following drugs is the most potent inhibitor of the hepatic p450 metabolic pathway?
Ritonavir
Saquinavir
Rifampin
Nevirapine
Abacavir