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A 40-year-old man with AIDS and a CD4 count of 80/mm 3 has a fever and a right lower lobe infiltrate. Which of the following organisms would be considered to be the most likely cause of his pneumonia if recovered from BAL fluid (bronchoalveolar lavage)? Cytomegalovirus Herpes simplex

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slide1

A 40-year-old man with AIDS and a CD4 count of 80/mm3 has a fever and a right lower lobe infiltrate. Which of the following organisms would be considered to be the most likely cause of his pneumonia if recovered from BAL fluid (bronchoalveolar lavage)?

  • Cytomegalovirus
  • Herpes simplex
  • Legionella
  • Enterobacter cloacea
  • Candida albicans
slide2

A 40-year-old man with AIDS and a CD4 count of 80/mm3 has a fever and a right lower lobe infiltrate. Which of the following organisms would be considered to be the most likely cause of his pneumonia if recovered from BAL fluid (bronchoalveolar lavage)?

  • Cytomegalovirus
  • Herpes simplex
  • Legionella
  • Enterobacter cloacea
  • Candida albicans
slide3

A 32-year-old man with advanced HIV infection presents with cough and low grade fever of two weeks duration. He has a history of PCP, thrush, ITP, and wasting. Recent medications include ddI, d4T, nelfinavir, dapsone, nystatin, and prednisone. Chest x-ray shows a cavity lesion measuring 4 cm in the right lower lobe. A BAL yields Candida albicans, Nocardia asteroides, P. aeruginosa, and CMV. Which of the following antibiotics should be given?

  • Ganciclovir
  • Amphotericin B
  • Fluconazole
  • Ceftazidime
  • Trimethoprim-sulfamethoxazole
slide4

A 32-year-old man with advanced HIV infection presents with cough and low grade fever of two weeks duration. He has a history of PCP, thrush, ITP, and wasting. Recent medications include ddI, d4T, nelfinavir, dapsone, nystatin, and prednisone. Chest x-ray shows a cavity lesion measuring 4 cm in the right lower lobe. A BAL yields Candida albicans, Nocardia asteroides, P. aeruginosa, and CMV. Which of the following antibiotics should be given?

  • Ganciclovir
  • Amphotericin B
  • Fluconazole
  • Ceftazidime
  • Trimethoprim-sulfamethoxazole
slide5

A 25-year-old HIV-infected man presents to your office with severe herpes proctitis. The patient has been treated with acyclovir, 200 mg five times daily for six weeks without improvement in the lesions. On repeat culture of the rectum, herpes simplex virus 2 is again isolated and further testing reveals that this is a thymidine kinase-deficient strain. Which is the preferred treatment option for this condition?

  • Foscarnet
  • Vidarabine
  • Ganciclovir
  • Valacyclovir
  • Famciclovir
slide6

A 25-year-old HIV-infected man presents to your office with severe herpes proctitis. The patient has been treated with acyclovir, 200 mg five times daily for six weeks without improvement in the lesions. On repeat culture of the rectum, herpes simplex virus 2 is again isolated and further testing reveals that this is a thymidine kinase-deficient strain. Which is the preferred treatment option for this condition?

  • Foscarnet
  • Vidarabine
  • Ganciclovir
  • Valacyclovir
  • Famciclovir
slide7

A 43-year-old man with AIDS presents with a four-week history of ataxia, progressive right hand weakness, and tremor. Physical examination confirms his symptoms. His CD4 cell count is 56/mm3, and serum antitoxoplasma IgG antibody titer was negative one year ago. An MRI of the head reveals a solitary 2 x 4 cm lesion in the left cerebellar hemisphere which gives a high signal intensity on T2-weighted images but does not enhance with gadolinium. No mass effect is demonstrated. The most likely diagnosis is:

  • Toxoplasmosis
  • A fungal abscess
  • Primary CNS lymphoma
  • Progressive multifocal leukoencephalopathy (PML)
  • A mycobacterial abscess
slide8

A 43-year-old man with AIDS presents with a four-week history of ataxia, progressive right hand weakness, and tremor. Physical examination confirms his symptoms. His CD4 cell count is 56/mm3, and serum antitoxoplasma IgG antibody titer was negative one year ago. An MRI of the head reveals a solitary 2 x 4 cm lesion in the left cerebellar hemisphere which gives a high signal intensity on T2-weighted images but does not enhance with gadolinium. No mass effect is demonstrated. The most likely diagnosis is:

  • Toxoplasmosis
  • A fungal abscess
  • Primary CNS lymphoma
  • Progressive multifocal leukoencephalopathy (PML)
  • A mycobacterial abscess
slide9

A 37-year-old man with advanced HIV infection hospitalized with a fever to 40C, BP 80/60, chills, headache, and diarrhea with 3-5 stools/day for two days. He has a history of PCP x 2, CMV retinitis treated with IV ganciclovir, aphthous ulcers in the mouth, and thrush. Current medications include d4T, ddI, ritonavir, Fortovase, ganciclovir, fluconazole, dapsone, Megace, and vitamins. PE shows only fever and thrush; the Hickman catheter site appears clean and fundoscopic exam shows no new CMV lesions. Lab studies show: WBC 4,200/dL, hematocrit 22%; Chemistry panel-normal except for AST 56 U/L, creatinine 130 mmol/L; Clear chest x-ray; Negative CSF analysis (cryptococcal antigen pending); Stool studies including C. difficile toxin assay are pending. After cultures, treatment should begin immediately with which of the following?

  • Trimethoprim-sulfamethoxazole
  • Oral vancomycin
  • Ceftazidime plus vancomycin
  • Amphotericin B
  • No antimicrobial treatment pending results of cultures (blood, urine and stool)
slide10

A 37-year-old man with advanced HIV infection hospitalized with a fever to 40C, BP 80/60, chills, headache, and diarrhea with 3-5 stools/day for two days. He has a history of PCP x 2, CMV retinitis treated with IV ganciclovir, aphthous ulcers in the mouth, and thrush. Current medications include d4T, ddI, ritonavir, Fortovase, ganciclovir, fluconazole, dapsone, Megace, and vitamins. PE shows only fever and thrush; the Hickman catheter site appears clean and fundoscopic exam shows no new CMV lesions. Lab studies show: WBC 4,200/dL, hematocrit 22%; Chemistry panel- normal except for AST 56 U/L, creatinine 130 mmol/L; Clear chest x-ray; Negative CSF analysis (cryptococcal antigen pending); Stool studies including C. difficile toxin assay are pending. After cultures, treatment should begin immediately with which of the following?

  • Trimethoprim-sulfamethoxazole
  • Oral vancomycin
  • Ceftazidime plus vancomycin
  • Amphotericin B
  • No antimicrobial treatment pending results of cultures (blood, urine and stool)
slide11

Which of the following drugs accelerates the p450 metabolic pathway?

  • Indinavir
  • Delavirdine
  • Saquinavir
  • Nevirapine
  • Nelfinavir
slide12

Which of the following drugs accelerates the p450 metabolic pathway?

  • Indinavir
  • Delavirdine
  • Saquinavir
  • Nevirapine
  • Nelfinavir
slide13

Which of the following shows the best penetration into the central nervous system?

  • Nevirapine
  • Indinavir
  • Nelfinavir
  • ddI
  • ddC
slide14

Which of the following shows the best penetration into the central nervous system?

  • Nevirapine
  • Indinavir
  • Nelfinavir
  • ddI
  • ddC
slide15

Which of the following best predicts long-term HIV suppression?

  • The nadir of plasma HIV RNA levels following treatment
  • Treatment in relatively early stage disease as indicated by a CD4 count >200/mm3
  • A relatively low plasma HIV RNA level at the time antiretroviral therapy is initiated
  • Absence of an AIDS-defining opportunistic infection
  • Use of a regimen that contains 2 protease inhibitors
slide16

Which of the following best predicts long-term HIV suppression?

  • The nadir of plasma HIV RNA levels following treatment
  • Treatment in relatively early stage disease as indicated by a CD4 count >200/mm3
  • A relatively low plasma HIV RNA level at the time antiretroviral therapy is initiated
  • Absence of an AIDS-defining opportunistic infection
  • Use of a regimen that contains 2 protease inhibitors
slide17

Which of the following is least likely to cause peripheral neuropathy?

  • Lamivudine (3TC)
  • Stavudine (d4T)
  • Didanosine (ddI)
  • Zalcitabine (ddC)
slide18

Which of the following is least likely to cause peripheral neuropathy?

  • Lamivudine (3TC)
  • Stavudine (d4T)
  • Didanosine (ddI)
  • Zalcitabine (ddC)
slide19

Which of the following may cause a deceptively high CD4 cell count?

  • HTLV II co-infection
  • Splenectomy
  • Major surgery
  • Pregnancy
  • Acute administration of corticosteroids
slide20

Which of the following may cause a deceptively high CD4 cell count?

  • HTLV II co-infection
  • Splenectomy
  • Major surgery
  • Pregnancy
  • Acute administration of corticosteroids
slide21

Antiretroviral Drugs Approved by FDA for HIV

Generic Name

Class

Firm

FDA Approval Date

zidovudine, AZT

NRTI

Glaxo Wellcome

March 87

didanosine, ddI

NRTI

Bristol Myers-Squibb

October 91

zalcitabine, ddC

NRTI

Hoffman-La Roche

June 92

stavudine, d4T

NRTI

Bristol Myers-Squibb

June 94

lamivudine, 3TC

NRTI

Glaxo Wellcome

November 95

saquinavir, SQV, hgc

PI

Hoffman-La Roche

December 95

ritonavir, RTV

PI

Abbott Laboratories

March 96

indinavir, IDV

PI

Merck & Co., Inc.

March 96

nevirapine, NVP

NNRTI

Boehringer Ingelheim

June 96

nelfinavir, NFV

PI

Agouron Pharmaceuticals

March 97

delavirdine, DLV

NNRTI

Pharmacia & Upjohn

April 97

zidovudine and lamivudine

NRTI

Glaxo Wellcome

September 97

saquinavir, SQV, sgc

PI

Hoffman-La Roche

November 97

efavirenz, EFV

NNRTI

DuPont Pharmaceuticals

September 98

abacavir, ABC

NRTI

Glaxo Wellcome

February 99

amprenavir

PI

Glaxo Wellcome

April 99

slide22

Which of the following vaccines is contraindicated in patients with HIV infection due to the potential to cause infection?

  • Tetanus
  • Influenza
  • Varicella
  • Haemophilus influenzae type B
  • Hepatitis A virus
slide23

Which of the following vaccines is contraindicated in patients with HIV infection due to the potential to cause infection?

  • Tetanus
  • Influenza
  • Varicella
  • Haemophilus influenzae type B
  • Hepatitis A virus
slide24

Positive serology showing antibody usually indicates which of the following organisms is not present?

  • Toxoplasma gondii
  • Cytomegalovirus
  • Epstein-Barr virus
  • Hepatitis B virus
  • Varicella-zoster
slide25

Positive serology showing antibody usually indicates which of the following organisms is not present?

  • Toxoplasma gondii
  • Cytomegalovirus
  • Epstein-Barr virus
  • Hepatitis B virus
  • Varicella-zoster
slide26

Which of the following microbes is most likely to cause a cerebrospinal fluid showing elevated protein and a polymorphonuclear pleocytosis in late-stage HIV infection?

a. Toxoplasma gondii

b. Cytomegalovirus

c. Treponema pallidum

d. JC virus (Progressive multifocal leukoencephalopathy)e.Herpes simplex

slide27

Which of the following microbes is most likely to cause a cerebrospinal fluid showing elevated protein and a polymorphonuclear pleocytosis in late-stage HIV infection?

a. Toxoplasma gondii

b. Cytomegalovirus

c. Treponema pallidum

d. JC virus (Progressive multifocal leukoencephalopathy)e.Herpes simplex

slide28

The most common cause of fever of unknown origin with no focal symptoms in a previously untreated patient with a CD4 count of 10/mm3 is:

  • Disseminated M. avium infection
  • Disseminated cytomegalovirus
  • Pneumocystis carinii pneumonia
  • Toxoplasmosis
  • Lymphoma
slide29

The most common cause of fever of unknown origin with no focal symptoms in a previously untreated patient with a CD4 count of 10/mm3 is:

  • Disseminated M. avium infection
  • Disseminated cytomegalovirus
  • Pneumocystis carinii pneumonia
  • Toxoplasmosis
  • Lymphoma
slide30

Which of the following fungi is an agent of disseminated infections primarily in southeastern or eastern Asia?

  • Penicillium marneffei
  • Coccidioides immitis
  • Histoplasma capsulatum
  • Blastomyces dermatitidis
  • Paracoccidioides brasiliensis
slide31

Which of the following fungi is an agent of disseminated infections primarily in southeastern or eastern Asia?

  • Penicillium marneffei
  • Coccidioides immitis
  • Histoplasma capsulatum
  • Blastomyces dermatitidis
  • Paracoccidioides brasiliensis
slide32

A 45-year-old woman donated blood prior to elective surgery for urinary incontinence. The blood bank reports that the unit is repeatedly reactive in a HIV-1 enzyme immunoassay (EIA), with a negative HIV-1 Western blot. A test done 1 year previously showed the same results. She has no history of blood transfusion or injection drug use, and has been sexually monogamous for ten years with a single partner who has no known HIV risk factors. Your advice is:

  • Defer surgery until repeat HIV testing can be done at three months
  • Advise the patient that she has early HIV infection
  • Perform testing on her sexual partner to determine if he is the source of the infection
  • Test the patient's sexual partner for HIV
  • Inform the patient that HIV infection is unlikely given the absence of risk factors and the negative Western blot result
slide33

A 45-year-old woman donated blood prior to elective surgery for urinary incontinence. The blood bank reports that the unit is repeatedly reactive in a HIV-1 enzyme immunoassay (EIA), with a negative HIV-1 Western blot. A test done 1 year previously showed the same results. She has no history of blood transfusion or injection drug use, and has been sexually monogamous for ten years with a single partner who has no known HIV risk factors. Your advice is:

  • Defer surgery until repeat HIV testing can be done at three months
  • Advise the patient that she has early HIV infection
  • Perform testing on her sexual partner to determine if he is the source of the infection
  • Test the patient's sexual partner for HIV
  • Inform the patient that HIV infection is unlikely given the absence of risk factors and the negative Western blot result
slide34

All of the following are correct about hairy leukoplakia except:

  • It will respond to treatment with acyclovir
  • It will respond to treatment with ganciclovir
  • It is a rare complication of diseases other than HIV infection
  • It is usually not treated
  • Scrapings of it will show pseudomycelia
slide35

All of the following are correct about hairy leukoplakia except:

  • It will respond to treatment with acyclovir
  • It will respond to treatment with ganciclovir
  • It is a rare complication of diseases other than HIV infection
  • It is usually not treated
  • Scrapings of it will show pseudomycelia
slide36

A 27-year-old intravenous drug abuser is referred to you with positive HIV serology. He is asymptomatic but continues to practice high risk behavior. Past medical history indicates herpes zoster involving the right leg one year ago. Initial evaluation shows the following: WBC 3,400 with 72% PMNs, 5% bands, 15% lymphocytes, 3% monocytes; CD4 count 240/mm3; Chemistry panel normal; Hepatitis serology HBsAg neg and anti-HBs positive; VDRL negative; Chest x-ray negative; PPD negative. Treatment at this time should include which of the following?

  • Pneumovax
  • Azithromycin prophylaxis
  • PCP prophylaxis
  • Hepatitis B vaccine
  • Acyclovir
slide37

A 27-year-old intravenous drug abuser is referred to you with positive HIV serology. He is asymptomatic but continues to practice high risk behavior. Past medical history indicates herpes zoster involving the right leg one year ago. Initial evaluation shows the following: WBC 3,400 with 72% PMNs, 5% bands, 15% lymphocytes, 3% monocytes; CD4 count 240/mm3; Chemistry panel normal; Hepatitis serology HBsAg neg and anti-HBs positive; VDRL negative; Chest x-ray negative; PPD negative. Treatment at this time should include which of the following?

  • Pneumovax
  • Azithromycin prophylaxis
  • PCP prophylaxis
  • Hepatitis B vaccine
  • Acyclovir
slide38

Which of the following is correct about Stavudine (d4T)?

  • The major side effect is peripheral neuropathy.
  • High level resistance occurs early in treatment when it is given as monotherapy.
  • It penetrates the blood-brain barrier better than AZT
  • Tablets should be chewed or dissolved in fluids before swallowing
  • It commonly causes lactic acidosis
slide39

Which of the following is correct about Stavudine (d4T)?

  • The major side effect is peripheral neuropathy.
  • High level resistance occurs early in treatment when it is given as monotherapy.
  • It penetrates the blood-brain barrier better than AZT
  • Tablets should be chewed or dissolved in fluids before swallowing
  • It commonly causes lactic acidosis
slide40

Which of the following conditions in a person with HIV infection is suggestive of the greatest degree of immunosuppression?

  • Peripheral generalized lymphadenopathy
  • Thrush
  • Pneumonia due to S. pneumoniae
  • Cavitary pulmonary tuberculosis
  • Vaginal candidiasis
slide41

Which of the following conditions in a person with HIV infection is suggestive of the greatest degree of immunosuppression?

  • Peripheral generalized lymphadenopathy
  • Thrush
  • Pneumonia due to S. pneumoniae
  • Cavitary pulmonary tuberculosis
  • Vaginal candidiasis
slide42

A HIV-infected patient has cough, fever, and sputum production for 4 days. A chest x-ray shows a left lower lobe infiltrate, the WBC is 4,200/mm3 and a CD4 count is 150/mm3. He takes no medication. The most likely microbial pathogen is:

  • S. pneumoniae
  • Mycobacterium tuberculosis
  • Rhodococcus equii
  • P. carinii
  • Cryptococcosis
slide43

A HIV-infected patient has cough, fever, and sputum production for 4 days. A chest x-ray shows a left lower lobe infiltrate, the WBC is 4,200/mm3 and a CD4 count is 150/mm3. He takes no medication. The most likely microbial pathogen is:

  • S. pneumoniae
  • Mycobacterium tuberculosis
  • Rhodococcus equii
  • P. carinii
  • Cryptococcosis
slide44

A HIV-infected woman has headache, fever, and a seizure. The CD4 count is 56/mm3, WBC is 3,200/mm3, and a MRI shows two ring-enhancing lesions. She takes no medicines other than methadone. The most likely diagnosis is:

  • Lymphoma
  • Toxoplasmosis
  • Cryptococcosis
  • PML
  • Herpes simplex encephalitis
slide45

A HIV-infected woman has headache, fever, and a seizure. The CD4 count is 56/mm3, WBC is 3,200/mm3, and a MRI shows two ring-enhancing lesions. She takes no medicines other than methadone. The most likely diagnosis is:

  • Lymphoma
  • Toxoplasmosis
  • Cryptococcosis
  • PML
  • Herpes simplex encephalitis
slide46

Which of the following does not have verified benefit in reducing perinatal transmission?

  • Intrapartum nevirapine
  • Intrapartum AZT
  • Intrapartum indinavir
  • C-section
  • Reduction in viral load during pregnancy
slide47

Which of the following does not have verified benefit in reducing perinatal transmission?

  • Intrapartum nevirapine
  • Intrapartum AZT
  • Intrapartum indinavir
  • C-section
  • Reduction in viral load during pregnancy
slide48

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
slide49

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
slide50

Which of the following drugs has been associated with serious hypersensitivity reactions characterized by fever, GI distress, and rash?

  • Efavirenz
  • Hydroxyurea
  • Abacavir
  • Saquinavir
  • Nelfinavir
slide51

Which of the following drugs has been associated with serious hypersensitivity reactions characterized by fever, GI distress, and rash?

  • Efavirenz
  • Hydroxyurea
  • Abacavir
  • Saquinavir
  • Nelfinavir
slide52

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
slide53

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
slide54

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
slide55

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
slide56

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
slide57

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
slide58

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
slide59

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
slide60

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
slide61

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
slide62

The most common side-effect of nelfinavir is:

  • Epigastric pain
  • Diarrhea
  • Headache
  • Nephrolithiasis
  • Neuropathy
slide63

The most common side-effect of nelfinavir is:

  • Epigastric pain
  • Diarrhea
  • Headache
  • Nephrolithiasis
  • Neuropathy
slide64

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?

a. AZT

b. Trimethoprim-sulfamethoxazole

c. Ketoconazole

d. ddI e. Vitamin C

slide65

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?

a. AZT

b. Trimethoprim-sulfamethoxazole

c. Ketoconazole

d. ddI e. Vitamin C

slide66

Albendazole is effective therapy for most patients infected by:

a. Toxoplasma gondii

b. Enterocytozoon bienusi

c. Septata intestinalis

d. Cryptosporidia e. Cyclospora

slide67

Albendazole is effective therapy for most patients infected by:

a. Toxoplasma gondii

b. Enterocytozoon bienusi

c. Septata intestinalis

d. Cryptosporidia e. Cyclospora

slide68

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%
slide69

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%
slide70

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
slide71

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
slide72

Fecal leukocytes are most likely with diarrhea due to:

a. Mycobacterium

b. Septata intestinalis

c. Cryptosporidium

d. Isospora e. Cytomegalovirus

slide73

Fecal leukocytes are most likely with diarrhea due to:

a. Mycobacterium

b. Septata intestinalis

c. Cryptosporidium

d. Isosporae. Cytomegalovirus

slide74

A 28-year old gay man has progressive dyspnea and hypoxemia over 2-3 months. He is afebrile and has a CD4 count of 26/mm3. Chest x-ray shows alveolar infiltrates bilaterally, hilar adenopathy and a pleural effusion. Bronchscopy with BAL and a transbronchial biopsy is negative. A gallium scan negative. The most likely cause is:

a. Histoplasmosis

b. Coccidiodomycosis c. Lymphocytic interstitial pneumonia d. Lymphoma e. Kaposi sarcoma

slide75

A 28-year old gay man has progressive dyspnea and hypoxemia over 2-3 months. He is afebrile and has a CD4 count of 26/mm3. Chest x-ray shows alveolar infiltrates bilaterally, hilar adenopathy and a pleural effusion. Bronchscopy with BAL and a transbronchial biopsy is negative. A gallium scan negative. The most likely cause is:

a. Histoplasmosis

b. Coccidiodomycosis c. Lymphocytic interstitial pneumonia d. Lymphoma e. Kaposi sarcoma

slide76

Which of the following drugs is recommended for AIDS patients with bacillary angiomatosis?

  • Penicillin
  • Ciprofloxacin
  • Erythromycin
  • Cephalosporin
  • Vancomycin
slide77

Which of the following drugs is recommended for AIDS patients with bacillary angiomatosis?

  • Penicillin
  • Ciprofloxacin
  • Erythromycin
  • Cephalosporin
  • Vancomycin
slide78

Which of the following drugs is the most potent inhibitor of the hepatic p450 metabolic pathway?

  • Ritonavir
  • Saquinavir
  • Rifampin
  • Nevirapine
  • Abacavir
slide79

Which of the following drugs is the most potent inhibitor of the hepatic p450 metabolic pathway?

  • Ritonavir
  • Saquinavir
  • Rifampin
  • Nevirapine
  • Abacavir
slide80

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
slide81

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
slide82

Which of the following drugs have been associated with hypertriglyceridemia?

  • Ritonavir
  • Hydroxyurea
  • Delavirdine
  • Abacavir
  • Stavudine (d4T)
slide83

Which of the following drugs have been associated with hypertriglyceridemia?

  • Ritonavir
  • Hydroxyurea
  • Delavirdine
  • Abacavir
  • Stavudine (d4T)
slide84

Which of the following is not detected with AFB stain of stool in patients with diarrhea?

a. Cryptosporidia parvum

b. Cyclospora cayetanensis c. Isospora belli d. Microsporidia e. Septata intestinalis

slide85

Which of the following is not detected with AFB stain of stool in patients with diarrhea?

a. Cryptosporidia parvum

b. Cyclospora cayetanensisc. Isospora bellid. Microsporidia e. Septata intestinalis

slide86

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
slide87

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
slide88

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
slide89

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