Practice questions HIV infection
Practice questions
HIV infection
© Jun Wang, MD, PhD
1. Use this case for next seven questions. A 24-year-old man presents to the clinic with a 5-day history of fever, sore throat, myalgias, diarrhea and diffuse maculopapular rash on his trunk. He returned 2 months ago from an international trip where he ate food from street vendors and engaged in unprotected sexual intercourse with a few partners. His past medical history is positive for type 1 diabetes. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using marijuana for the last 2 years. Physical examination reveals generalized lymphadenopathy and a faint nonpruritic rash on the chest. Rapid tests from flu and COVID are negative. Which of the following is the most appropriate next step in diagnosis?
B. HIV-1/2 antibody differentiation immunoassay
C. HIV RNA PCR test
D. Monospot test
E. Rapid plasma reagin
2. A 24-year-old man presents to the clinic with a 5-day history of fever, sore throat, myalgias, diarrhea and diffuse maculopapular rash on his trunk. He returned 2 months ago from an international trip where he ate food from street vendors and engaged in unprotected sexual intercourse with a few partners. His past medical history is positive for type 1 diabetes. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using marijuana for the last 2 years. Physical examination reveals generalized lymphadenopathy and a faint nonpruritic rash on the chest. Rapid tests from flu and COVID are negative.
HIV p24 and antibody tests are negative. Which of the following is the most appropriate next step in diagnosis?
B. HIV-1/2 antibody differentiation immunoassay
C. HIV RNA PCR test
D. Monospot test
E. Rapid plasma reagin
3. A 24-year-old man presents to the clinic with a 5-day history of fever, sore throat, myalgias, diarrhea and diffuse maculopapular rash on his trunk. He returned 2 months ago from an international trip where he ate food from street vendors and engaged in unprotected sexual intercourse with a few partners. His past medical history is positive for type 1 diabetes. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using marijuana for the last 2 years. Physical examination reveals generalized lymphadenopathy and a faint nonpruritic rash on the chest. Rapid tests from flu and COVID are negative. HIV p24 and antibody tests are negative.
Molecular test is positive for HIV-1 RNA. What is the diagnosis?
B. Acquired immunodeficiency syndrome
C. Asymptomatic HIV infection
D. Chronic HIV infection
4. A 24-year-old man presents to the clinic with a 5-day history of fever, sore throat, myalgias, diarrhea and diffuse maculopapular rash on his trunk. He returned 2 months ago from an international trip where he ate food from street vendors and engaged in unprotected sexual intercourse with a few partners. His past medical history is positive for type 1 diabetes. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using marijuana for the last 2 years. Physical examination reveals generalized lymphadenopathy and a faint nonpruritic rash on the chest. Rapid tests from flu and COVID are negative. HIV p24 and antibody tests are negative. Molecular test is positive for HIV-1 RNA but not HIV-2. What is the major target of this virus?
B. CD8+ T cells
C. CD19+ B cells
D. CD56+ lymphocytes
E. GI tract epithelial cells
5. A 24-year-old man presents to the clinic with a 5-day history of fever, sore throat, myalgias, diarrhea and diffuse maculopapular rash on his trunk. He returned 2 months ago from an international trip where he ate food from street vendors and engaged in unprotected sexual intercourse with a few partners. His past medical history is positive for type 1 diabetes. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using marijuana for the last 2 years. Physical examination reveals generalized lymphadenopathy and a faint nonpruritic rash on the chest. Rapid tests from flu and COVID are negative. HIV p24 and antibody tests are negative. Molecular test is positive for HIV-1 RNA but not HIV-2. What viral component is essential for initial binding to target host cells?
B. p17
C. p24
D. p41
E. p120
6. A 24-year-old man presents to the clinic with a 5-day history of fever, sore throat, myalgias, diarrhea and diffuse maculopapular rash on his trunk. He returned 2 months ago from an international trip where he ate food from street vendors and engaged in unprotected sexual intercourse with a few partners. His past medical history is positive for type 1 diabetes. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using marijuana for the last 2 years. Physical examination reveals generalized lymphadenopathy and a faint nonpruritic rash on the chest. Rapid tests from flu and COVID are negative. HIV p24 and antibody tests are negative. Molecular test is positive for HIV-1 RNA but not HIV-2. What additional laboratory test is likely to be seen in this patient?
B. Elevated CD19+ B cells
C. Reduced CD4+ T cells
D. Reduced CD8+ cells
E. Thrombocytosis
7. A 24-year-old man presents to the clinic with a 5-day history of fever, sore throat, myalgias, diarrhea and diffuse maculopapular rash on his trunk. He returned 2 months ago from an international trip where he ate food from street vendors and engaged in unprotected sexual intercourse with a few partners. His past medical history is positive for type 1 diabetes. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using marijuana for the last 2 years. Physical examination reveals generalized lymphadenopathy and a faint nonpruritic rash on the chest. Rapid tests from flu and COVID are negative. HIV p24 and antibody tests are negative. Molecular test is positive for HIV-1 RNA but not HIV-2. What is the most significant risk of his presentations?
B. Cigarette smoking
C. Hyperglycemia
D. Marijuana usage
E. Sexual activity
8. . Use this case for next three questions. A 27-year-old man presents to the clinic with a 5-day history of fever and diarrhea. He has a history of sickle cell anemia and has received a few blood transfusions. The last transfusion was 2 weeks ago. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using intravenous drug for the last 2 years. Physical examination reveals cervical and axillary lymphadenopathy. His CBC reveals a hemoglobin of 9 g/dL (14-18 g/dL), white cell count of 12 x 109/L (4.5-11 x 109/L) and platelet count of 250 x 109/L (150-450 x 109/L). Peripheral blood smears reveals scattered sickle cells. No morphological abnormalities are seen in white cells and platelets. His coagulation, liver and renal function panels and bilirubin are within normal range. HIV p24 and antibody tests are negative. Molecular test is positive for HIV-1 RNA but not HIV-2. What is most likely the cause of his presentations?
B. Blood transfusion
C. Cigarette smoking
D. Intravenous drug usage
E. Sexual activity
9. A 27-year-old man presents to the clinic with a 5-day history of fever and diarrhea. He has a history of sickle cell anemia and has received a few blood transfusions. The last transfusion was 2 weeks ago. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using intravenous drug for the last 2 years. Physical examination reveals cervical and axillary lymphadenopathy. His CBC reveals a hemoglobin of 9 g/dL (14-18 g/dL), white cell count of 12 x 109/L (4.5-11 x 109/L) and platelet count of 250 x 109/L (150-450 x 109/L). Peripheral blood smears reveals scattered sickle cells. No morphological abnormalities are seen in white cells and platelets. His coagulation, liver and renal function panels and bilirubin are within normal range. HIV p24 and antibody tests are negative. Molecular test is positive for HIV-1 RNA but not HIV-2. What is most likely the pathological finding of his lymph nodes?
B. Fibrotic bands and binucleated lymphocytes
D. Localized growth of monotonous small lymphocytes
E. Sheets of large atypical B cells
10. A 27-year-old man presents to the clinic with a 5-day history of fever and diarrhea. He has a history of sickle cell anemia and has received a few blood transfusions. The last transfusion was 2 weeks ago. He has a 10 pack-year history of cigarette smoking, drinks 3 beers every day, and has been using intravenous drug for the last 2 years. Physical examination reveals cervical and axillary lymphadenopathy. His CBC reveals a hemoglobin of 9 g/dL (14-18 g/dL), white cell count of 12 x 109/L (4.5-11 x 109/L) and platelet count of 250 x 109/L (150-450 x 109/L). Peripheral blood smears reveals scattered sickle cells. No morphological abnormalities are seen in white cells and platelets. His coagulation, liver and renal function panels and bilirubin are within normal range. HIV p24 and antibody tests are negative. Molecular test is positive for HIV-1 RNA but not HIV-2. What is most likely the diagnosis?
B. Acquired immunodeficiency syndrome
C. Asymptomatic HIV infection
D. Chronic HIV infection
E. Delayed hemolytic transfusion reaction
11. Use this case for next four questions. A 41-year-old man presents to the HIV clinic for follow-up. He was diagnosed with HIV infection 2 years ago and is currently taking ART. He does not have fever or weight loss. Physical examination reveals scattered slightly enlarged lymph nodes around his neck, axilla and inguinal area. His liver and renal function tests are within normal ranges. What blood cell is likely to have a lower than normal level?
B. CD8+ lymphocytes
C. Hemoglobin
D. Neutrophil count
E. Platelets
12. A 41-year-old man presents to the HIV clinic for follow-up. He was diagnosed with HIV infection 2 years ago and is currently taking ART. He does not have fever or weight loss. Physical examination reveals scattered slightly enlarged lymph nodes around his neck, axilla and inguinal area. His liver and renal function tests are within normal ranges. His routine CBC results are within normal ranges. His CD4+ T cells count is 450/mcl (500-1200/mcl). Comparing with the time his HIV infection was diagnosed, what test result is likely to be elevated?
B. p24 antibody
C. p24 antigen
D. Viral RNA load
13. A 41-year-old man presents to the HIV clinic for follow-up. He was diagnosed with HIV infection 2 years ago and is currently taking ART. He does not have fever or weight loss. Physical examination reveals scattered slightly enlarged lymph nodes around his neck, axilla and inguinal area. His liver and renal function tests are within normal ranges. His routine CBC results are within normal ranges. His CD4+ T cells count is 450/mcl (500-1200/mcl). What is the diagnosis of this patient?
B. Acquired immunodeficiency syndrome
C. Asymptomatic HIV infection
14. A 41-year-old man presents to the HIV clinic for follow-up. He was diagnosed with HIV infection 2 years ago and is currently taking ART. He does not have fever or weight loss. Physical examination reveals scattered slightly enlarged lymph nodes around his neck, axilla and inguinal area. His liver and renal function tests are within normal ranges. His routine CBC results are within normal ranges. His CD4+ T cells count is 450/mcl (500-1200/mcl). Further studies revealed proviral DNA within host genome. What viral components are essential for this change of host genome?
B. Integrase and protease
C. P7 and P9
D. P24 and reverse transcriptase
E. Reverse transcriptase and integrase
15. A 42-year-old man presents to the clinic with progressive fatigue over the past month. He has unintentionally lost 15 pounds in this period. He has been HIV positive for 5 years. He is not currently on antiretroviral therapy. Physical examination reveals oral thrush and a few enlarged lymph nodes in the axillary and inguinal area. Laboratory reveals a CD4+ count of 150/mm³ (500-1200/mcl). What is the diagnosis?
B. Acquired immunodeficiency syndrome
C. Asymptomatic HIV infection
D. Chronic HIV infection
16. Use this case for next two questions. A 36-year-old man presents to the emergency department with progressive shortness of breath, nonproductive cough, and low-grade fever for the past two weeks. He has a history of untreated HIV infection for 5 years and has not been on any medications for the last 6 months. He has a heart rate of 100/min, a respiratory rate of 26/min, and an oxygen saturation of 89% on room air. His blood pressure is within normal range. Chest auscultation reveals clear breath sounds. Chest X-ray shows bilateral interstitial infiltrates. Laboratory testing reveals a CD4+ T cell count of 220/mcl (500-1200/mcl). An image of his bronchoalveolar lavage with silver stain is shown. What is the diagnosis?
B. Acquired immunodeficiency syndrome
C. Asymptomatic HIV infection
D. Chronic HIV infection
17. A 36-year-old man presents to the emergency department with progressive shortness of breath, nonproductive cough, and low-grade fever for the past two weeks. He has a history of untreated HIV infection for 5 years and has not been on any medications for the last 6 months. He has a heart rate of 100/min, a respiratory rate of 26/min, and an oxygen saturation of 89% on room air. His blood pressure is within normal range. Chest auscultation reveals clear breath sounds. Chest X-ray shows bilateral interstitial infiltrates. Laboratory testing reveals a CD4+ T cell count of 220/mcl (500-1200/mcl). An image of his bronchoalveolar lavage with silver stain is shown. What is the cause of his presentations?
(Image credit: Public domain, https://picryl.com/media/pneumocystis-carinii-in-smear-from-bal-01ee046-lores-f3576e)
B. Cytomegalovirus
C. Mycobacterium avium complex
D. Pneumocystis jirovicii
E. Toxoplasma gondii
18. A 39-year-old man presents to the emergency department with confusion, headache, and difficulty walking for the past 4 days. He was diagnosed with HIV infection 4 years ago but has not been taking any medications. He has a temperature of 101.1°F (38.4°C). Other vital signs are within normal ranges. Physical examination reveals disorientation to time and place, left-sided weakness, and hyperreflexia. Laboratory studies show a CD4+ T cell count of 35/mcl (500-1200/mcl). MRI of the brain reveals multiple ring-enhancing lesions with surrounding edema in the basal ganglia and cerebral cortex. What is the most likely diagnosis?
B. Toxoplasma encephalitis
C. Progressive multifocal leukoencephalopathy
D. Cryptococcal meningitis
E. Cytomegalovirus encephalitis
19. A 38-year-old man presents to the emergency department with worsening headache, intermittent fever, and increasing confusion for 1 week, and more lethargic and slow to respond over the past few days. He has been HIV positive for 6 years. His temperature is 100.9°F (38.3°C). Other vital signs are within normal range. Physical examination reveals scattered papules with central pitting on his face and chest. No neck stiffness, photophobia, nor other focal neurologic deficits are noted. Fundoscopic exam is normal. His CD4+ T cell count is 40/mcl (500-1200/mcl). An image of his CSF with india ink is shown. What is most likely the cause of his presentations?
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(Image credit: Ed Uthman from Houston, TX, USA, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Candida albicans
C. Cryptococcus neoformans
D. Cryptosporidium
E. Cytomegalovirus
20. A 40-year-old man presents to the Emergency Department with shortness of breath pain, nonproductive cough, and low-grade fever for 3 days. He has been HIV positive for 10 years. He is not currently on antiretroviral therapy. He has a temperature of 100.9°F (38.3°C), a respiratory rate of 22/min, and an oxygen saturation of 90% on room air. Chest auscultation reveals fine bibasilar crackles. Chest CT reveals bilateral ground-glass opacities. His last CD4+ T cell count performed 1 month ago was 25/mcl (500-1200/mcl). An image of his lung biopsy is shown. What is the most likely cause of his respiratory presentations?
(Image credit: CDC/ Dr. Edwin P. Ewing, Jr., CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
B. Cytomegalovirus
C. Epstein-Barr virus
D. Herpes simplex virus
E. Pneumocystis jirovicci
21. A 36-year-old man presents to the clinic with a 5-day history of progressive visual disturbance in his right eye. He describes it as blurry vision with occasional floaters but no eye pain. Hi has been HIV positive for 4 years but not currently on antiretroviral therapy. He has a history of type I diabetes. His laboratory tests reveals a A1c of 7.5% (normal< 5.7%). His CD4+ T cell count is 30/mcl (500-1200/mcl). An image of his fundoscopic exam is shown. What is most likely causing his vision presentations?
(Image credit: S Sudharshan, Sudha K Ganesh, Jyotirmay Biswas, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons)
B. Cytomegalovirus
C. Human herpes virus 8
D. JC polyoma virus
E. Toxoplasma gondii
22. A 45-year-old man presents to the clinic with progressive memory loss, slowed thinking, and difficulty with concentration over the past several months. He has been HIV positive for 10 years. His partner notes that he often forgets recent conversations and has become increasingly withdrawn and apathetic. He is compliant with his antiretroviral therapy. His CD4+ T cell count is 120/mcl (500-1200/mcl) and his HIV viral load has elevated. Neurologic examination is non-focal. Mini-Mental State Examination score is 23/30. Brain MRI shows mild diffuse cortical atrophy but no focal lesions. Serologic tests for syphilis and hepatitis B are negative, and cerebrospinal fluid analysis is unremarkable. What is the most likely diagnosis?
B. Progressive multifocal leukoencephalopathy
C. Alzheimer disease
D. Cryptococcal meningoencephalitis
E. Cytomegalovirus encephalitis
23. A 44-year-old man presents to the clinic with numbness and burning pain in both feet for the past 3 weeks. The symptoms are gradually worsening and are now affecting his ability to walk comfortably. He has a 7-year history of HIV and is currently on antiretroviral therapy. His CD4+ T cell count is 180/mcl (500-1200/mcl), and viral load is undetectable. Physical examination reveals decreased pinprick and temperature sensation bilaterally, with preserved motor strength. Deep tendon reflexes are diminished at the ankles. His CBC are within normal ranges. What is most likely the diagnosis?
B. HIV-associated distal symmetric polyneuropathy
C. HIV-associated neurocognitive disorder
D. Tabes dorsalis
E. Vitamin B12 deficiency
24. A 38-year-old man presents with a 2-week history of lower extremity swelling and decreased urine output. He does not have fever, rash, or recent infections. He has a history of HIV diagnosed 5 years ago but has not been adherent to antiretroviral therapy. His past medical history is otherwise unremarkable. His vital signs are within normal ranges. Physical exam reveals periorbital edema and 2+ pitting edema of both legs. Laboratory study results include:
A1c: 5.2% (<5.7%)
BUN: 46 mg/dL (7-30 mg/dL)
CD4+ T cell count: 60/mm³ (500-1200/mcl).
HIV viral load: >100,000 copies/mL
Urinalysis: 4+ protein, no hematuria, no casts
Urine protein/creatinine ratio: 5.2 (<0.2)
ANA, anti-dsDNA, and ANCA: negative
Renal ultrasound: normal-sized echogenic kidneys
Which of the following is the most likely diagnosis?
B. Hypertensive nephrosclerosis
C. HIV-associated nephropathy
D. Membranous nephropathy
E. IgA nephropathy
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