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)?

a. Cytomegalovirus b. Herpes simplex c. Legionella d. Enterobacter cloacea e. Candida albicans

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)?

a. CytomegalovirusCytomegalovirus b. Herpes simplexHerpes simplex c. Legionella d. Enterobacter cloaceaEnterobacter cloacea e. Candida albicansCandida albicans

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?

a. Ganciclovir b. Amphotericin B c. Fluconazole d. Ceftazidime e. Trimethoprim-sulfamethoxazole

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?

a. GanciclovirGanciclovir b. Amphotericin BAmphotericin B c. FluconazoleFluconazole d. CeftazidimeCeftazidime e. Trimethoprim-sulfamethoxazole

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?

a. Foscarnet b. Vidarabine c. Ganciclovir d. Valacyclovir e. Famciclovir

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?

a. Foscarnet b. VidarabineVidarabine c. GanciclovirGanciclovir d. ValacyclovirValacyclovir e. FamciclovirFamciclovir

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:

a. Toxoplasmosis b. A fungal abscess c. Primary CNS lymphoma d. Progressive multifocal leukoencephalopathy (PML) e. A mycobacterial abscess

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:

a. ToxoplasmosisToxoplasmosis b. A fungal abscessA fungal abscess c. Primary CNS lymphomaPrimary CNS lymphoma d. Progressive multifocal leukoencephalopathy (PML) e. A mycobacterial abscessmycobacterial abscess

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?

a. Trimethoprim-sulfamethoxazole b. Oral vancomycin c. Ceftazidime plus vancomycin d. Amphotericin B e. No antimicrobial treatment pending results of cultures (blood, urine

and stool)

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?

a. Trimethoprim-sulfamethoxazoleTrimethoprim-sulfamethoxazole b. Oral vancomycinOral vancomycin c. Ceftazidime plus vancomycin d. Amphotericin BAmphotericin B e. No antimicrobial treatment pending results of cultures (blood, urine No antimicrobial treatment pending results of cultures (blood, urine

and stool)and stool)

Which of the following drugs accelerates the p450 metabolic pathway?

a. Indinavir b. Delavirdine c. Saquinavird. Nevirapine e. Nelfinavir

Which of the following drugs accelerates the p450 metabolic pathway?

a. IndinavirIndinavir b. DelavirdineDelavirdine c. SaquinavirSaquinavird. Nevirapine e. NelfinavirNelfinavir

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

a. Nevirapine b. Indinavir c. Nelfinavir d. ddI e. ddC

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

a. Nevirapine b. IndinavirIndinavir c. NelfinavirNelfinavir d. ddIddI e. ddCddC

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

a. The nadir of plasma HIV RNA levels following treatment

b. Treatment in relatively early stage disease as indicated by a CD4 count >200/mm3

c. A relatively low plasma HIV RNA level at the time antiretroviral therapy is initiated

d. Absence of an AIDS-defining opportunistic infection e. Use of a regimen that contains 2 protease inhibitors

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

a. The nadir of plasma HIV RNA levels following treatment

b. Treatment in relatively early stage disease as indicated Treatment in relatively early stage disease as indicated by a CD4 count >200/mmby a CD4 count >200/mm33

c. A relatively low plasma HIV RNA level at the time A relatively low plasma HIV RNA level at the time antiretroviral therapy is initiatedantiretroviral therapy is initiated

d. Absence of an AIDS-defining opportunistic infectionAbsence of an AIDS-defining opportunistic infection e. Use of a regimen that contains 2 protease inhibitorsUse of a regimen that contains 2 protease inhibitors

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

a. Lamivudine (3TC) b. Stavudine (d4T) c. Didanosine (ddI) d. Zalcitabine (ddC)

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

a. Lamivudine (3TC) b. Stavudine (d4T)Stavudine (d4T) c. Didanosine (ddI)Didanosine (ddI) d. Zalcitabine (ddC)Zalcitabine (ddC)

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

a. HTLV II co-infection b. Splenectomy c. Major surgery d. Pregnancy e. Acute administration of corticosteroids

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

a. HTLV II co-infectionHTLV II co-infection b. Splenectomy c. Major surgeryMajor surgery d. PregnancyPregnancy e. Acute administration of corticosteroidsAcute administration of corticosteroids

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

Antiretroviral Drugs Approved by FDA for HIVAntiretroviral Drugs Approved by FDA for HIV

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

a. Tetanus b. Influenza c. Varicella d. Haemophilus influenzae type B e. Hepatitis A virus

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

a. TetanusTetanus b. InfluenzaInfluenza c. Varicella d. Haemophilus influenzae type BHaemophilus influenzae type B e. Hepatitis A virusHepatitis A virus

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

a. Toxoplasma gondii b. Cytomegalovirus c. Epstein-Barr virus d. Hepatitis B virus e. Varicella-zoster

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

a. Toxoplasma gondiiToxoplasma gondii b. CytomegalovirusCytomegalovirus c. Epstein-Barr virusEpstein-Barr virus d. Hepatitis B virus e. Varicella-zosterVaricella-zoster

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

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 gondiia. Toxoplasma gondii b. Cytomegalovirus c. Treponema pallidumc. Treponema pallidum d. JC virus (Progressive multifocal leukoencephalopathy)d. JC virus (Progressive multifocal leukoencephalopathy) e.e. Herpes simplexHerpes simplex

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:

a. Disseminated M. avium infection b. Disseminated cytomegalovirus c. Pneumocystis carinii pneumonia d. Toxoplasmosis e. Lymphoma

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:

a. Disseminated M. avium infection b. Disseminated cytomegalovirusDisseminated cytomegalovirus c. Pneumocystis carinii pneumoniaPneumocystis carinii pneumonia d. ToxoplasmosisToxoplasmosis e. LymphomaLymphoma

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

a. Penicillium marneffei b. Coccidioides immitis c. Histoplasma capsulatum d. Blastomyces dermatitidis e. Paracoccidioides brasiliensis

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

a. Penicillium marneffei b. Coccidioides immitisCoccidioides immitis c. Histoplasma capsulatumHistoplasma capsulatum d. Blastomyces dermatitidisBlastomyces dermatitidis e. Paracoccidioides brasiliensisParacoccidioides brasiliensis

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:

a. Defer surgery until repeat HIV testing can be done at three months b. Advise the patient that she has early HIV infection c. Perform testing on her sexual partner to determine if he is the source of

the infection d. Test the patient's sexual partner for HIV e. Inform the patient that HIV infection is unlikely given the absence of

risk factors and the negative Western blot result

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:

a. Defer surgery until repeat HIV testing can be done at three monthsDefer surgery until repeat HIV testing can be done at three months b. Advise the patient that she has early HIV infectionAdvise the patient that she has early HIV infection c. Perform testing on her sexual partner to determine if he is the source of Perform testing on her sexual partner to determine if he is the source of

the infectionthe infection d. Test the patient's sexual partner for HIVTest the patient's sexual partner for HIV e. Inform the patient that HIV infection is unlikely given the absence of

risk factors and the negative Western blot result

All of the following are correct about hairy leukoplakia except:

a. It will respond to treatment with acyclovir b. It will respond to treatment with ganciclovir c. It is a rare complication of diseases other than HIV

infection d. It is usually not treated e. Scrapings of it will show pseudomycelia

All of the following are correct about hairy leukoplakia except:

a. It will respond to treatment with acyclovirIt will respond to treatment with acyclovir b. It will respond to treatment with ganciclovirIt will respond to treatment with ganciclovir c. It is a rare complication of diseases other than HIV It is a rare complication of diseases other than HIV

infectioninfection d. It is usually not treatedIt is usually not treated e. Scrapings of it will show pseudomycelia

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?

a. Pneumovax b. Azithromycin prophylaxis c. PCP prophylaxis d. Hepatitis B vaccine e. Acyclovir

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?

a. Pneumovax b. Azithromycin prophylaxisAzithromycin prophylaxis c. PCP prophylaxisPCP prophylaxis d. Hepatitis B vaccineHepatitis B vaccine e. AcyclovirAcyclovir

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

a. The major side effect is peripheral neuropathy. b. High level resistance occurs early in treatment when it is

given as monotherapy. c. It penetrates the blood-brain barrier better than AZTd. Tablets should be chewed or dissolved in fluids before

swallowing e. It commonly causes lactic acidosis

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

a. The major side effect is peripheral neuropathy. b. High level resistance occurs early in treatment when it is High level resistance occurs early in treatment when it is

given as monotherapy.given as monotherapy. c. It penetrates the blood-brain barrier better than AZTIt penetrates the blood-brain barrier better than AZTd. Tablets should be chewed or dissolved in fluids before Tablets should be chewed or dissolved in fluids before

swallowingswallowing e. It commonly causes lactic acidosisIt commonly causes lactic acidosis

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

a. Peripheral generalized lymphadenopathy b. Thrush c. Pneumonia due to S. pneumoniae d. Cavitary pulmonary tuberculosis e. Vaginal candidiasis

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

a. Peripheral generalized lymphadenopathyPeripheral generalized lymphadenopathy b. Thrush c. Pneumonia due to S. pneumoniaePneumonia due to S. pneumoniae d. Cavitary pulmonary tuberculosisCavitary pulmonary tuberculosis e. Vaginal candidiasisVaginal candidiasis

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:

a. S. pneumoniae b. Mycobacterium tuberculosis c. Rhodococcus equii d. P. carinii e. Cryptococcosis

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:

a. S. pneumoniae b. Mycobacterium tuberculosisMycobacterium tuberculosis c. Rhodococcus equiiRhodococcus equii d. P. cariniiP. carinii e. CryptococcosisCryptococcosis

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:

a. Lymphoma b. Toxoplasmosis c. Cryptococcosis d. PML e. Herpes simplex encephalitis

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:

a. LymphomaLymphoma b. Toxoplasmosis c. CryptococcosisCryptococcosis d. PMLPML e. Herpes simplex encephalitisHerpes simplex encephalitis

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

a. Intrapartum nevirapine b. Intrapartum AZT c. Intrapartum indinavir d. C-section e. Reduction in viral load during pregnancy

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

a. Intrapartum nevirapineIntrapartum nevirapine b. Intrapartum AZTIntrapartum AZT c. Intrapartum indinavir d. C-sectionC-section e. Reduction in viral load during pregnancyReduction in viral load during pregnancy

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:

a. Salmonellosisb. C. difficile colitis c. Microsporidia d. Irritable bowel syndrome e. Kaposi's sarcoma of the gut

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:

a. SalmonellosisSalmonellosisb. C. difficile colitisC. difficile colitis c. MicrosporidiaMicrosporidia d. Irritable bowel syndrome e. Kaposi's sarcoma of the gutKaposi's sarcoma of the gut

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

a. Efavirenz b. Hydroxyurea c. Abacavir d. Saquinavire. Nelfinavir

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

a. EfavirenzEfavirenz b. HydroxyureaHydroxyurea c. Abacavir d. SaquinavirSaquinavire. NelfinavirNelfinavir

The opportunistic organism most likely to infect the adrenal gland in patients with advanced HIV infection is:

a. M. avium b. Histoplasma capsulatum c. Candida albicans d. CMV e. Cryptococcus neoformans

The opportunistic organism most likely to infect the adrenal gland in patients with advanced HIV infection is:

a. M. aviumM. avium b. Histoplasma capsulatumHistoplasma capsulatum c. Candida albicansCandida albicans d. CMV e. Cryptococcus neoformansCryptococcus neoformans

Which of the following is most likely to show no white blood cells in cerebrospinal fluid?

a. Toxoplasma encephalitis b. CNS lymphoma c. Progressive multifocal leukoencephalopathy d. Neurosyphilis e. CMV encephalitis

Which of the following is most likely to show no white blood cells in cerebrospinal fluid?

a. Toxoplasma encephalitisToxoplasma encephalitis b. CNS lymphomaCNS lymphoma c. Progressive multifocal leukoencephalopathy d. NeurosyphilisNeurosyphilis e. CMV encephalitisCMV encephalitis

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?

a. Repeat the CD4-cell count in the same lab b. Repeat the CD4-cell count, but use a different lab c. Request a complete T-subset analysis d. Obtain additional studies for HIV staging including B2

microglobulin and neopterin e. Do nothing and see the patient in 3 months

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?

a. Repeat the CD4-cell count in the same labRepeat the CD4-cell count in the same lab b. Repeat the CD4-cell count, but use a different labRepeat the CD4-cell count, but use a different lab c. Request a complete T-subset analysisRequest a complete T-subset analysis d. Obtain additional studies for HIV staging including B2 Obtain additional studies for HIV staging including B2

microglobulin and neopterinmicroglobulin and neopterin e. Do nothing and see the patient in 3 months

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?

a. S. epidermidis b. Microsporidiac. Blastocystis hominis d. Cryptosporidia e. M. avium complex

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?

a. S. epidermidis S. epidermidis b. MicrosporidiaMicrosporidiac. Blastocystis hominis Blastocystis hominis d. CryptosporidiaCryptosporidia e. M. avium complex

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:

a. p24 antigen b. Routine serologic test c. HIV DNA assay d. HIV RNA level e. HIV culture

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:

a. p24 antigen p24 antigen b. Routine serologic test c. HIV DNA assayHIV DNA assay d. HIV RNA levelHIV RNA level e. HIV cultureHIV culture

The most common side-effect of nelfinavir is:

a. Epigastric pain b. Diarrhea c. Headache d. Nephrolithiasis e. Neuropathy

The most common side-effect of nelfinavir is:

a. Epigastric painEpigastric pain b. Diarrhea c. HeadacheHeadache d. NephrolithiasisNephrolithiasis e. NeuropathyNeuropathy

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

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 a. AZT b. Trimethoprim-sulfamethoxazole b. Trimethoprim-sulfamethoxazole c. Ketoconazole c. Ketoconazole d. ddI d. ddI e. Vitamin C

Albendazole is effective therapy for most patients infected by:

a. Toxoplasma gondii b. Enterocytozoon bienusi c. Septata intestinalis d. Cryptosporidia e. Cyclospora

Albendazole is effective therapy for most patients infected by:

a. Toxoplasma gondii a. Toxoplasma gondii b. Enterocytozoon bienusib. Enterocytozoon bienusi c. Septata intestinalis d. Cryptosporidia d. Cryptosporidia e. Cyclosporae. Cyclospora

The average efficiency of HIV transmission with a single episode of unprotected receptive vaginal intercourse with an untreated HIV infected source is approximately?

a. 30% b. 3% c. 0.3% d. 0.03% e. 0.003%

The average efficiency of HIV transmission with a single episode of unprotected receptive vaginal intercourse with an untreated HIV infected source is approximately?

a. 30% 30% b. 3%3% c. 0.3% d. 0.03% 0.03% e. 0.003%0.003%

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?

a. IVIG b. Prednisone c. Splenic irradiation d. Danazol e. No treatment

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?

a. IVIG IVIG b. Prednisone Prednisone c. Splenic irradiation Splenic irradiation d. Danazol Danazol e. No treatment

Fecal leukocytes are most likely with diarrhea due to:

a. Mycobacterium b. Septata intestinalis c. Cryptosporidium d. Isospora e. Cytomegalovirus

Fecal leukocytes are most likely with diarrhea due to:

a. Mycobacterium a. Mycobacterium b. Septata intestinalis b. Septata intestinalis c. Cryptosporidium c. Cryptosporidium d. Isosporad. Isospora e. Cytomegalovirus

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

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

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

a. Penicillin b. Ciprofloxacin c. Erythromycin d. Cephalosporin e. Vancomycin

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

a. Penicillin Penicillin b. CiprofloxacinCiprofloxacin c. Erythromycin d. Cephalosporin Cephalosporin e. VancomycinVancomycin

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

a. Ritonavir b. Saquinavir c. Rifampin d. Nevirapine e. Abacavir

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

a. Ritonavir b. Saquinavir Saquinavir c. Rifampin Rifampin d. Nevirapine Nevirapine e. AbacavirAbacavir

Most patients in late-stage HIV infection develop toxoplasmosis from which of the following?

a. New infection following exposure to cat stool b. New infection following exposure to undercooked meat c. New infection from exposure to a patient with

toxoplasmosis d. New infection from contaminated water e. Activation of latent infection

Most patients in late-stage HIV infection develop toxoplasmosis from which of the following?

a. New infection following exposure to cat stool New infection following exposure to cat stool b. New infection following exposure to undercooked meat New infection following exposure to undercooked meat c. New infection from exposure to a patient with New infection from exposure to a patient with

toxoplasmosis toxoplasmosis d. New infection from contaminated waterNew infection from contaminated water e. Activation of latent infection

Which of the following drugs have been associated with hypertriglyceridemia?

a. Ritonavir b. Hydroxyurea c. Delavirdine d. Abacavir e. Stavudine (d4T)

Which of the following drugs have been associated with hypertriglyceridemia?

a. Ritonavir b. Hydroxyurea Hydroxyurea c. Delavirdine Delavirdine d. Abacavir Abacavir e. Stavudine (d4T) Stavudine (d4T)

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

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

a. Cryptosporidia parvum a. Cryptosporidia parvum b. Cyclospora cayetanensisb. Cyclospora cayetanensis c. Isospora belli d. Microsporidia d. Microsporidia e. Septata intestinalise. Septata intestinalis

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:

a. T. pallidum b. Toxoplasma gondii c. Cryptococcus d. Progressive multifocal leukoencephalopathy e. H. simplex

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:

a. T. pallidum T. pallidum b. Toxoplasma gondiiToxoplasma gondii c. Cryptococcus d. Progressive multifocal leukoencephalopathy Progressive multifocal leukoencephalopathy e. H. simplexH. simplex

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:

a. Giardia b. E. histolytica c. C. difficile d. Salmonella e. Cryptosporidia

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:

a. Giardia Giardia b. E. histolytica E. histolytica c. C. difficile C. difficile d. SalmonellaSalmonella e. Cryptosporidia