Category: Quiz

Lungs in hiv

LUNGS IN HIV

Q. 1 An 66—year—old AIDS patient with pneumonia has a bronchoalveolar lavage that demonstrates small, “hat-shaped” structures in alveoli that are about the size of an erythrocyte and stain with silver stains. The microo­rganism involved is most likely which of the following?
 A Blastomyces dermatitidis
 B Mycobacterium a vium
 C Mycobacterium tuberculosis
 D Pneumocystis carinii
Q. 1 An 66—year—old AIDS patient with pneumonia has a bronchoalveolar lavage that demonstrates small, “hat-shaped” structures in alveoli that are about the size of an erythrocyte and stain with silver stains. The microo­rganism involved is most likely which of the following?
 A Blastomyces dermatitidis
 B Mycobacterium a vium
 C Mycobacterium tuberculosis
 D Pneumocystis carinii
Ans. D

Explanation:

Pneumocystis carinii


Q. 2

An AIDS patient with clinical pneumonia has a bronchoalveolar lavage that demonstrates small, “hat- shaped” structures in alveoli that are about the size of an erythrocyte and stain with silver stains. The microorganism involved is most likely which of the following?

 A

Aspergillus fumigatus

 B

Blastomyces dermatitidis

 C

Mycobacterium avium

 D

Pneumocystis carinii

Q. 2

An AIDS patient with clinical pneumonia has a bronchoalveolar lavage that demonstrates small, “hat- shaped” structures in alveoli that are about the size of an erythrocyte and stain with silver stains. The microorganism involved is most likely which of the following?

 A

Aspergillus fumigatus

 B

Blastomyces dermatitidis

 C

Mycobacterium avium

 D

Pneumocystis carinii

Ans. D

Explanation:

This is the classic appearance of Pneumocystis cysts. Pneumocystis is a common (and dangerous) cause of pneumonia in AIDS patients
. The diagnosis is now frequently made by bronchoalveolar lavage, which is much more effective at demonstrating the organism than is either sputum or blood culture.
 
Aspergillus fumigatus is a typical fungus, and hyphae would probably have been seen in the lavage material.
 
Blastomycosis is caused by a dimorphic fungus that grows in mammalian tissues as a round, multinucleate, budding cell 8-15 micrometers in diameter.
 
Mycobacteria  are small, acid-fast rods.
 
Ref: Ray C.G., Ryan K.J. (2010). Chapter 45. Candida, Aspergillus, Pneumocystis,and Other Opportunistic Fungi. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.

Q. 3

Most common agent causing tuberculosis in AIDS patient in tropical countries is –

 A

Mycobacterium tuberculosis

 B

Mycobacterium intracellulare

 C

Mycobacterium parvum

 D

Mycobacterium atypical

Q. 3

Most common agent causing tuberculosis in AIDS patient in tropical countries is –

 A

Mycobacterium tuberculosis

 B

Mycobacterium intracellulare

 C

Mycobacterium parvum

 D

Mycobacterium atypical

Ans. A

Explanation:

Ans. is ‘a’ i.e., Mycobacterium tuberculosis 

Common pathogens causing T.B. in AIDS patients are M. tuberculosis and M. avium intracellulare. In developing countries, the most important pathogen is M. tuberculosis, with many strain being multidrug resistant.

Also know

.        Most common cardiac manifestation                 Dilated cardiomyopathy.

.        Most common dermatological manifestation      Seborrheic dermatitis

.        Most common hematological abnormality   –> Anemia

.        Most common endocrine abnormality             -> Lipodystrophy (due to HAART)

.        Most common Hepatobiliary problem               Infection with Hepatitis B

Remember

.            T.B. is one of the conditions associated with HIV infection for which cure is possible.

.            The classical x-ray finding of P carinii infection i.e., a dense perihilar infiltrate is unusual in patient with AIDS.

.            Patients receiving aerosolized pentamidine for prophylaxis for P carinii, may develop extrapulmonary

manifestations of P. carinii.


Q. 4

Which of the following mycobacteria can cause disease in HIV+ve patient with a CD4 count of 600/ cu.mm?

 A

M. tuberculosis

 B

MAC

 C

M. chelonei

 D

M. fortuitum

Q. 4

Which of the following mycobacteria can cause disease in HIV+ve patient with a CD4 count of 600/ cu.mm?

 A

M. tuberculosis

 B

MAC

 C

M. chelonei

 D

M. fortuitum

Ans. A

Explanation:

Ans. is ‘a’ i.e., M. Tuberculosis

. MAC infection occurs when CD4 + T cells counts are < 50/ml, in contrast M. tuberculosis infection develops early

in the course with CD4 T cells counts > 300/ml.


Q. 5

A patient suffering from AIDS presents with history of dyspnea and non- productive cough x-ray shows bilateral perihilar opacities without pleural effusion and lymphaden-opathy. Most probable etiological agent is :

 A

Tuberculosis

 B

CMV

 C

Kaposis sarcoma

 D

Pneumocystis carinii

Q. 5

A patient suffering from AIDS presents with history of dyspnea and non- productive cough x-ray shows bilateral perihilar opacities without pleural effusion and lymphaden-opathy. Most probable etiological agent is :

 A

Tuberculosis

 B

CMV

 C

Kaposis sarcoma

 D

Pneumocystis carinii

Ans. D

Explanation:

D i.e. Pneumocystic carinii


Q. 6

A 45 year old, HIV positive patient presents with features of pneumonia. Characteristic histopathological features suggesting pneumocystis carinii pneumonia is:

 A

Prominent Interstitial Pneumonitis

 B

Eosinophilic Alveolar Exudates

 C

Prominent mononuclear cells in Alveolar exudates

 D

Neutrophilic infiltration of alveolar interstitium

Q. 6

A 45 year old, HIV positive patient presents with features of pneumonia. Characteristic histopathological features suggesting pneumocystis carinii pneumonia is:

 A

Prominent Interstitial Pneumonitis

 B

Eosinophilic Alveolar Exudates

 C

Prominent mononuclear cells in Alveolar exudates

 D

Neutrophilic infiltration of alveolar interstitium

Ans. B

Explanation:

Answer is B (Eosinophilic Alveolar Exudate):

The most characteristic histoputhological feature of pneumocystis carinii pneumonia in adults is predominantly alveolar, foamy vacuoloted, eosinophilic exudates.

Interstitial pneumonitis is usually mild and shows infiltration with PML and mononuclear cells.


Q. 7

Respiratory system infections in HIV is seen with:

September 2005

 A

Streptococcus

 B

H.influenzae

 C

Pneumocystii

 D

All of the above

Q. 7

Respiratory system infections in HIV is seen with:

September 2005

 A

Streptococcus

 B

H.influenzae

 C

Pneumocystii

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

Pulmonary disease is one of the most frequent complications of HIV.

The most common manifestation of pulmonary disease is pneumonia.

The two most common cause of pneumonia are bacterial infections (S.pneumoniae and H.influenzae) and the unicellular fungus P.jiroveci infection.


Q. 8

Chest X-ray findings in tuberculosis associated with HIV are all except:    

September 2005

 A

Disseminated tuberculosis

 B

Lupus vulgaris

 C

Pleural effusion

 D

Hilar lymphadenopathy

Q. 8

Chest X-ray findings in tuberculosis associated with HIV are all except:    

September 2005

 A

Disseminated tuberculosis

 B

Lupus vulgaris

 C

Pleural effusion

 D

Hilar lymphadenopathy

Ans. B

Explanation:

Ans. B: Lupus vulgaris

Lupus vulgaris is a cutaneous manifestation of tuberculosis.



Toxoplasma gondii: Toxoplasmosis

Toxoplasma gondii: Toxoplasmosis

Q. 1

Scenario: An infant with congenital toxoplasmosis is treated with pyrimethamine for one year. The diagnosis was late to be made. 
 
Assertion: Detection of IgM and IgG specific antibody in fetus is helpful in diagnosing congenital toxoplasmosis since it cross placenta.
 
Reason: Serological diagnosis is based on the Persistence of IgG antibody or positive IgM titer after first week of life.
   
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 1

Scenario: An infant with congenital toxoplasmosis is treated with pyrimethamine for one year. The diagnosis was late to be made. 
 
Assertion: Detection of IgM and IgG specific antibody in fetus is helpful in diagnosing congenital toxoplasmosis since it cross placenta.
 
Reason: Serological diagnosis is based on the Persistence of IgG antibody or positive IgM titer after first week of life.
   
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. D

Explanation:

Antibodies in neonate may be either due to congenital infection (IgG, IgM) or due to passive transfer of antibodies from mother (IgG only).

So detection of IgM specific antibody in fetus is helpful in diagnosing congenital toxoplasmosis since it does not cross placenta.

Serological diagnosis is based on the Persistence of IgG antibody or positive IgM titer after first week of life.

Ref: Harrison’s, 17th Edition, Page 1310

Q. 2

Examination of a neonate shows features of IUGR, maculopapular rash, meningoencephalitis, neonatal hepatitis, chorioretinitis, microcephaly, periventricular calcification and thrombocytopenia. Following investigations a diagnosis of congenital toxoplasmosis is made.

Assertion: There is greater chance of transplacental infection when mother acquires infection during third trimester.

Reason: This neonate can be treated using pyrimethamine plus sulfadiazine.
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 2

Examination of a neonate shows features of IUGR, maculopapular rash, meningoencephalitis, neonatal hepatitis, chorioretinitis, microcephaly, periventricular calcification and thrombocytopenia. Following investigations a diagnosis of congenital toxoplasmosis is made.

Assertion: There is greater chance of transplacental infection when mother acquires infection during third trimester.

Reason: This neonate can be treated using pyrimethamine plus sulfadiazine.
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. B

Explanation:

Risk of congenital toxoplasmosis is greatest (65%) when the mother is infected during the third trimester. If mother is infected during the first trimester, incidence of transplacental infection is lowest (15%). Neonates when treated with pyrimethamine, sulfadiazine and folinic acid were found to have favourable long term outcome.

 

 

Ref: Harrison’s Principles of Internal Medicine, 18th Edition, Chapter 214.

 


Q. 3

All of the following statements about toxoplasmosis are true except –

 A

Oocyst in freshly passed cat’s faeces is infective

 B

May spread by organ transplantation

 C

Arthalgia, sore throat and abdominal pain are the most common manifestations

 D

a and c

Q. 3

All of the following statements about toxoplasmosis are true except –

 A

Oocyst in freshly passed cat’s faeces is infective

 B

May spread by organ transplantation

 C

Arthalgia, sore throat and abdominal pain are the most common manifestations

 D

a and c

Ans. D

Explanation:

Ans. is ‘a & c’ i.e., Oocyst in freshly passed cat’s faeces is infective; Arthalgia, sore throat and abdominal pain are the most common manifestations

.   The freshly passed oocyst is not infectious. It becomes infectious only after development in soil or water for few days-   

.    Infective forms

a)    Sporulated oocyst from contaminated soil.

b)    Tissue cyst containing bradyzoites in undercooked pork, beef or meat.

.  80-90% of immuno competant persons with toxoplasma infection are asymptomatic.

.   The most common manifestation is cervical lymphadenopathy.

Transmission of T. gondii

  1. a.  Ingestion of sporulated oocyst (Sporocyst) or tissue cyst containing bradyzoites (most common)   oral route.
  2. Blood transfusion.
  3. Kidney or heart transplant.
  4. Transplacental transmission.

Transmission of Toxoplasma infection in pregnancy

.  Congenital infections develop only when the nonimmunized mother develops infection during pregnancy or less than 6 months before pregnancy.

– The incidence of transplacental infection is lowest in first trimester but the disease in neonates is most severe.

The incidence of transplacental infection is highest in third trimester (after 6 months) but the infant is not severely affected.


Q. 4

True about toxoplasmosis is all except ‑

 A

In adults toxoplasmosis is usually asymptomatic

 B

IgG antibodies are diagnostic in Congenital toxoplasmosis

 C

Is a antroponotic disease

 D

Encephalitis is uncommon (rare) in immunocompetent individuals

Q. 4

True about toxoplasmosis is all except ‑

 A

In adults toxoplasmosis is usually asymptomatic

 B

IgG antibodies are diagnostic in Congenital toxoplasmosis

 C

Is a antroponotic disease

 D

Encephalitis is uncommon (rare) in immunocompetent individuals

Ans. B

Explanation:

Ans. is ‘b i.e., IgG Antibodies are diagnostic in congenital Toxoplasmosis

The presence of IgM (which does not cross placenta) in the infant’s circulation is diagnostic. Specific IgG in the infant’s circulation may be of maternal origin or due to infection.

Diagnosis of congenital toxoplasmosis ‑

1. PCR

.   PCR of the amniotic fluid to detect the B1 gene of the parasite has replaced fetal blood sampling.

2. Serology

.    The presence of IgM in infant’s circulation is diagnostic of congenital infection.

The double – sandwitch IgA – ELISA is more sensitive than the IgM- ELISA for detecting congenital infection in the fetus and newborn – Harrison 16th – 1309

.  Specific IgG in infant’s circulation may be of maternal origin or due to infection. Testing of infant’s blood at 2 monthly intervals will show whether the IgG antibody level is decreasing. At 6 – 10 months the infant’s circulation should not contain maternal IgG and therefore persistence of IgG beyond 6 -10 months is indicative of infection in the infant.

About other options

.    In immunocompetant adults, 80-90% infections are asymptomatic.

.   Toxoplasmosis is an anthropozoonoses ie : infection transmitted to man from vertebrate animals.

.  Encephalitis is a rare complication in immunocompetant patients.


Q. 5

Congenital toxoplasmosis false is –

 A

IgA is better than 1gM in detection

 B

Diagnosed by detection of IgM in cord blood

 C

IgG is diagnostic

 D

Not recalled

Q. 5

Congenital toxoplasmosis false is –

 A

IgA is better than 1gM in detection

 B

Diagnosed by detection of IgM in cord blood

 C

IgG is diagnostic

 D

Not recalled

Ans. C

Explanation:

Ans. is `c’ i.e., IgG is diagnostic

.   Congenital toxoplasmosis is diagnosed by the presence of IgM (which does not cross placenta) in the infant’s circulation.

.  Presence of IgG in the serum does not confirm the diagnosis because IgG can easily cross the placenta.

.    The presence of IgM in infant’s circulation is diagnostic of congenital infection.

The methods currently used to detect IgM are :

Double sandwich IgM ELISA

– IgM immunosorbent assay (IgM-ISAGA)

Both these assays are specific and sensitive

But remember an important point : ‑

The double sandwich IgA-ELISA is more sensitive than the IgM-ELISA for detecting congenital infection in the fetus and newborn.


Q. 6

Drug used in Toxoplasmosis is –

 A

Pyrimethamine

 B

Ribovarin

 C

Ganciclovir

 D

Tetracycline

Q. 6

Drug used in Toxoplasmosis is –

 A

Pyrimethamine

 B

Ribovarin

 C

Ganciclovir

 D

Tetracycline

Ans. A

Explanation:

Ans. is ‘a i.e., Pyrimethamine

o Doc for Toxoplasmosis Pyrimethamine and Sulfadiazine.

o Spiramycin is the DOC in pregnancy.

o For congenital infection and infection in immunocompetent patient pyrimethamine + sulfadiazine is the treatment of choice.

o For immunocompromized patients TMP-SMX is recommended.

o Other drugs used for toxoplasmosis – clindaymycin, Atovaquone, clarithromycin, Azithromycin, Dapsone­pyrimethamine.


Q. 7

Congenital toxoplasmosis-False is-

 A

Diagnosed by detection of IgM in cord blood

 B

IgA is more sensitive than IgM for detection

 C

Dye test is gold standard for IgG

 D

Avidity testing must be done to differentiate between IgA & IgM

Q. 7

Congenital toxoplasmosis-False is-

 A

Diagnosed by detection of IgM in cord blood

 B

IgA is more sensitive than IgM for detection

 C

Dye test is gold standard for IgG

 D

Avidity testing must be done to differentiate between IgA & IgM

Ans. D

Explanation:

Ans. is ‘d’ i.e., Avidity testing must be done to differentiate b/w IgA & IgM 

Avidity test is used to measure the strength of antigen-antibody reaction for IgG antibody (not to differentiate betweenIgA & IgM)

Toxoplasma immunoglobulins to diagnose congenital toxoplasmosis

1) IgG

o Presence of IgG in infants’s blood does not confirm the diagnosis of congenital toxoplasmosis because IgG can easily cross the placenta.

  • So, one cannot predict whether the IgG is of maternal origin or due to fetal infection.

o Transplacental IgG antibody disappears by 6-12 months of age.

  • Serological tests to detect IgG : –

i)        Sabin-Fieldman dye test (Most preferred IgG test)

ii)       1gG IFA test (IgG indirect fluorscent antibody test)

iii)    Differential agglutination (AC/HS) IgG test.

iv)    Avidity test : – It measure the strength of antigen-antibody reaction for IgG antibody.

2) IgM

o IgM does not cross the placenta; therefore, IgM is the test of choice for determining congenital infection.

o Serological tests for IgM are : –

i)           IgM IFA (indirect fluorscent antibody test)

ii)       Double sandwich enzyme linked immunosorbant assay : – More sensitive than IgM IFA.

iii)      immunosorbant agglutination assay (ISAGA)

3)IgA

o IgA may have greater sensitivity for neonate compared to IgM assay.

o Serological tests for IgA are : –

i) Double sandwich enzyme linked immunosorbant assay (IgA ELISA) : – It is better than double sandwich

IgM ELISA for diagnosis of congenital toxoplasmosis. The immunosorbant agglutination assay (ISAGA) IgA.



Q. 8

Diagnosis of toxoplasmosis in newborn is done by?

 A

IgG antibody against toxoplasma

 B

IgM antibodies to toxoplasma

 C

IgA antibodies to toxoplasma

 D

b and c

Q. 8

Diagnosis of toxoplasmosis in newborn is done by?

 A

IgG antibody against toxoplasma

 B

IgM antibodies to toxoplasma

 C

IgA antibodies to toxoplasma

 D

b and c

Ans. D

Explanation:

Ans. is `b > c’ i.e., IgM antibodies to toxoplasma > IgA antibodies to toxoplasma

o IgA has greater sensitivity, but IgM is the test of choice.


Q. 9

The most common manifestation of congenital toxoplasmosis –

 A

Hydrocephalus

 B

Chorioretinitis

 C

Hepatospienomegaly

 D

Thrombocytopenia

Q. 9

The most common manifestation of congenital toxoplasmosis –

 A

Hydrocephalus

 B

Chorioretinitis

 C

Hepatospienomegaly

 D

Thrombocytopenia

Ans. B

Explanation:

Ans. is ‘b’ i.e., Chorioretinitis


Q. 10

Recurrent toxoplasmic retinochoroiditis, all are true except:

 A

Manifests at an average age of 25 years

 B

The infestation is acquired by eating the under­cooked meat of intermediate host containing cyst of the parasite

 C

Typical lesion is a patch of focal necrotizing retinochoroiditis adjacent to a pigmented scar

 D

There may be associated iritis

Q. 10

Recurrent toxoplasmic retinochoroiditis, all are true except:

 A

Manifests at an average age of 25 years

 B

The infestation is acquired by eating the under­cooked meat of intermediate host containing cyst of the parasite

 C

Typical lesion is a patch of focal necrotizing retinochoroiditis adjacent to a pigmented scar

 D

There may be associated iritis

Ans. B

Explanation:

Ans. The infestation is acquired by eating the under­cooked meat of intermediate host containing cyst of the parasite


Q. 11

Most common eye pathology in toxoplasma infection is:         

March 2009

 A

Corneal ulcer

 B

Retinochoroiditis

 C

Uveitis

 D

Cataract

Q. 11

Most common eye pathology in toxoplasma infection is:         

March 2009

 A

Corneal ulcer

 B

Retinochoroiditis

 C

Uveitis

 D

Cataract

Ans. B

Explanation:

Ans. B: Retinochoroiditis

Intraocular features of toxoplasmosis infections are:

  • Macular scarring
  • Retinochoroiditis
  • Vitritis

When human retinal pigment epithelium (RPE) cells are infected with Toxoplasma gondii, there is an increased production of several cytokines including interleukin 1beta (IL-18), interleukin 6 (IL-6), granulocyte-macrophage colony-stimulating factor (GM-CSF), and intercellular adhesion molecule (ICAM).

Patients with acquired toxoplasmic retinochoroiditis exhibit higher levels of IL-1 than asymptomatic patients. IL-10 polymorphisms associated with a low production of IL-10 also appear to be associated with the occurrence of toxoplasmic retinochoroiditis.

Toxoplasma parasites are rarely identified in aqueous humor samples from patients with active ocular toxoplasmosis.


Q. 12

Most common clinical feature of toxoplasmosis in an immunocompetant adult‑

 A

Encephalitis

 B

Lymphladenopathy

 C

Chorioretinitis

 D

Glaucoma

Q. 12

Most common clinical feature of toxoplasmosis in an immunocompetant adult‑

 A

Encephalitis

 B

Lymphladenopathy

 C

Chorioretinitis

 D

Glaucoma

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lymphadenopathy

Clinical manifestation of toxoplasmosis

1.Adults

a) lmmunocompetant host

  • Asymptomic in 90% of patients.
  • M.C. clinical featur is cervical lymphadenopathy.
  • Other less common manifestations are pneumonia, myocarditis, encephalitis.

b) Immunocompromised host

  • M.C. signs and symptoms are principally within CNS —> Encephalopathy, Men ingoencephalitis.

2. Children

a) Congenital

  • May present with hydrocephalus, microcephaly mental retardation, deafness, blindness, epilepsy.
  • Intracerebral calcification may occur.

b) Acquired

  • Mostly asymptomatic
  • C/Fs are chorioretinitis (most common), cataract, glaucoma.

Q. 13

Drug of choice for toxoplasmosis in pregnancy ‑

 A

Cotrimoxazole

 B

Erythromycin

 C

Tetracycline

 D

Spiramycin

Q. 13

Drug of choice for toxoplasmosis in pregnancy ‑

 A

Cotrimoxazole

 B

Erythromycin

 C

Tetracycline

 D

Spiramycin

Ans. D

Explanation:

Ans. is ‘d’ i.e., Spiramycin 



HIV Involving Nervous System

HIV Involving Nervous System

Q. 1

Least common cause of seizures in AIDS patient is?

 A Toxoplasmosis
 B Cerebral lymphoma
 C Progressive multifocal leukoencephalopathy 
 D

Cryptococcal meningitis

Q. 1

Least common cause of seizures in AIDS patient is?

 A Toxoplasmosis
 B Cerebral lymphoma
 C Progressive multifocal leukoencephalopathy 
 D

Cryptococcal meningitis

Ans. C

Explanation:

Progressive multifocal leukoencephalopathy REF: Harrison’s Internal Medicine 17th edition chapter 182 Table 182-13 Causes of Seizures in Patients with HIV Infection

Disease

Overall Contribution to First Seizure, %

HIV encephalopathy

24-47

Cerebral toxoplasmosis

28

Cryptococcal meningitis

13

Primary central nervous system lymphoma

4

Progressive multifocal leukoencephalopathy

1


Q. 2

All of the following are pathologic features of brain in AIDS, EXCEPT:

 A

Perivascular giant cell invasion

 B

Microglial nodules

 C

Vasculitis

 D

Temporal lobe infarction

Q. 2

All of the following are pathologic features of brain in AIDS, EXCEPT:

 A

Perivascular giant cell invasion

 B

Microglial nodules

 C

Vasculitis

 D

Temporal lobe infarction

Ans. C

Explanation:

Pathologic features of brain in AIDS includes:
Gross:
  • Encephalitis: frontal /temporal cortical atrophy 
Histology:
Meningitis with mild lymphocytic infiltrates and scanty perivascular inflammation
Features of giant cell (HIV) encephalitis are:
  • Presence of microglial nodules
  • Pericapillary aggregates of multinucleated giant cells having generous or scanty neoplasm 
  • Perivascular lymphocytic cuffing
  • In leukoencephalopathy: there is diffuse diffuse demyelination and infiltration of macrophages and multinucleated giant cells.
Ref: Neuropathology,A Volume in the High Yield Pathology Series (Expert Consult …
 edited by Anthony T. Yachnis page 235.

Q. 3

Neurologic abnormalities have been noted in about one-third of patients with AIDS. Which of the following is NOT seen in HIV involvement of CNS?

 A

Perivascular giant cell

 B

Vacuolar degeneration of post column

 C

Microglial nodule formation

 D

Inclusion bodies

Q. 3

Neurologic abnormalities have been noted in about one-third of patients with AIDS. Which of the following is NOT seen in HIV involvement of CNS?

 A

Perivascular giant cell

 B

Vacuolar degeneration of post column

 C

Microglial nodule formation

 D

Inclusion bodies

Ans. D

Explanation:

The main cell types that are infected in the brain in HIV infection are the perivascular macrophages and the microglial cells.
A diffuse and multifocal rarefaction of the cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, and multinucleated giant cells.
Vacuolar degeneration of posterior column is associated with the AIDS dementia complex. 
 
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 33. Viral Infections of the Nervous System, Chronic Meningitis, and Prion Diseases. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor’s Principles of Neurology, 9e.  

 


Q. 4

Which of the following organism is the  most common cause of acute meningitis in an AIDS patient?

 A

Streptococcus pneumoniae

 B

Streptococcus agalactiae

 C

Cryptococcus neoformans

 D

Listeria monocytogenes

Q. 4

Which of the following organism is the  most common cause of acute meningitis in an AIDS patient?

 A

Streptococcus pneumoniae

 B

Streptococcus agalactiae

 C

Cryptococcus neoformans

 D

Listeria monocytogenes

Ans. C

Explanation:

Opportunistic infections of the CNS generally occur in HIV infected patients with CD4 counts below 200.

Most common organism that causes acute meningitis in an AIDS patients is Cyptococcus neoformans.
 
Cryptococcus neoformans is an encapsulated budding yeast that is found worldwide in soil and on dried pigeon dung.

Infections are acquired by inhalation.

In the lung, the infection may remain localized, heal, or disseminate.

Progressive lung disease and dissemination occur in cases of cellular immunodeficiency.
 
Ref: Current Medical Diagnosis and Treatment, 2012, Chapter 36

Q. 5

A 34 year old man with AIDS suddenly falls to the floor and has a tonic-clonic seizure. His concerned friends call paramedics, who take him to the hospital. On arrival at the hospital he is conscious, but confused. Physical examination is remarkable for cachexia and oral thrush. Neurological examination reveals isolated weakness of lateral gaze on the right. MRI reveals multicentric mass lesions in the brain and meninges. One of the masses is biopsied and appropriate immunohistochemical stains are performed. From which of the following cell types did the masses most likely derive?

 A

Astrocyte

 B

B lymphocyte

 C

Ependymal cell

 D

Melanocyte

Q. 5

A 34 year old man with AIDS suddenly falls to the floor and has a tonic-clonic seizure. His concerned friends call paramedics, who take him to the hospital. On arrival at the hospital he is conscious, but confused. Physical examination is remarkable for cachexia and oral thrush. Neurological examination reveals isolated weakness of lateral gaze on the right. MRI reveals multicentric mass lesions in the brain and meninges. One of the masses is biopsied and appropriate immunohistochemical stains are performed. From which of the following cell types did the masses most likely derive?

 A

Astrocyte

 B

B lymphocyte

 C

Ependymal cell

 D

Melanocyte

Ans. B

Explanation:

Approximately one-third of AIDS patients will experience significant morbidity from neurologic disease.
Primary CNS lymphoma is rare in the general population, but is a relatively common type of lymphoma in AIDS patients.

Presenting symptoms include seizures, headache, and cranial nerve deficits (e.g., the abducens nerve palsy in this patient). The lesions are often multicentric, and may involve the leptomeninges in a significant number of cases.
Primary CNS lymphoma is typically a late manifestation of AIDS (median CD4 count 40/μl).
This lymphoma is usually an intermediate-to-high-grade B cell lymphoma; evidence of Epstein- Barr virus infection is commonly present.Astrocytoma is a neoplasm derived from cells in the astrocyte lineage. These are not particularly associated with AIDS.
 
Ependymal cells line the ventricles. Tumors derived from ependymal cells, called ependymomas, characteristically produce rosettes or perivascular pseudorosettes, microscopically. The incidence of ependymoma is not increased in AIDS patients.
Melanoma is a neoplasm arising from transformation of melanocytic cells. Whereas the brain is a favorite site for metastatic melanoma, the incidence of melanoma is not particularly increased in AIDS patients.
 
Ref: Fayad L.E., Konoplev S., Chuang H.H., Rodriguez M.A., Dabaja B.S. (2011). Chapter 8. Aggressive and Highly Aggressive B-Cell Lymphomas. In H.M. Kantarjian, R.A. Wolff, C.A. Koller (Eds), The MD Anderson Manual of Medical Oncology, 2e.

Q. 6

What is the least common cause of seizures in AIDS patients?

 A

Toxoplasmosis

 B

Cerebral lymphoma

 C

Progressive multifocal leukoencephalopathy

 D

Cryptococcal meningitis

Q. 6

What is the least common cause of seizures in AIDS patients?

 A

Toxoplasmosis

 B

Cerebral lymphoma

 C

Progressive multifocal leukoencephalopathy

 D

Cryptococcal meningitis

Ans. C

Explanation:

Most common causes of seizures in AIDS patients are cerebral toxoplasmosis(40%), primary CNS lymphoma(15 – 35%), cryptococcal meningitis(8%) and HIV encephalopathy(7 -50%). Seizures can also be caused by less common causes such as CNS tuberculosis, aseptic meningitis and progressive multifocal leukoencephalopathy.


Q. 7

The most common organism amongst the following that causes acute meningitis in an AIDS patients is‑

 A

Streptococcus pneumoniae

 B

Steptococcus agalactiae

 C

Cryptococcus neoformans

 D

Listeria monocytogenes

Q. 7

The most common organism amongst the following that causes acute meningitis in an AIDS patients is‑

 A

Streptococcus pneumoniae

 B

Steptococcus agalactiae

 C

Cryptococcus neoformans

 D

Listeria monocytogenes

Ans. C

Explanation:

Ans. is ‘c’ i.e., Cryptococcus neoformans 

Neurological manifestations

.  Frequent opportunistic diseases of CNS are ‑

– Toxoplasmosis (most common cause of CNS infection in AIDS patients)

–   Cryptococcosis

–  Primary CNS lymphoma

–  Progressive multifocal leukoencephalopathy.

.  AIDS dementia complex (HIV encephalopathy) is a result of direct effects of HIV on CNS (not an opportunistic disease). It is subcortical dementia.

.  Most common cause of seizures                                 —>         Toxoplasma

.  Most common cause of meningitis                            –>           Cryptococcus

.  M.C. cause of focal neurological deficit                 –>           Toxoplasma


Q. 8

The most common organism amongst the following that causes acute meningitis in an AIDS patient is ‑

 A

Streptococcus pneumoniae

 B

Streptococcus agalactiae

 C

Cryptococcus neoformans

 D

Listeria monocytogenes

Q. 8

The most common organism amongst the following that causes acute meningitis in an AIDS patient is ‑

 A

Streptococcus pneumoniae

 B

Streptococcus agalactiae

 C

Cryptococcus neoformans

 D

Listeria monocytogenes

Ans. C

Explanation:

Ans. is c’ i.e., Cryptococcus neoformans

  • C. neoformans is the leading infections cause of meningitis in patients with AIDS.

Q. 9

Which of the following is not seen HIV involvement of CNS –

 A

Perivascular giant cell

 B

Vacuolar degeneration of post column

 C

Microglial nodule formation

 D

Inclusion bodies

Q. 9

Which of the following is not seen HIV involvement of CNS –

 A

Perivascular giant cell

 B

Vacuolar degeneration of post column

 C

Microglial nodule formation

 D

Inclusion bodies

Ans. D

Explanation:

Ans. is ‘d’ i.e., Inclusion bodies

CNS involvement in AIDS

o Involvement of C.N.S. is a common and important manifestation of AIDS.

  • In addition to the lymphoid system the nervous system is a major target of HIV infection.
  • Macrophages and microglia cells in the central nervous system that belongs to the monocyte and macrophages lineages are the predominant types in the brain that are infected with HIV.

o It is widely believed that HIV is carried into the brain by infected monocytes.

o Ninety percent of patients demonstrate some form of neurological involvement at autopsy.

o C.N.S. involvement in AIDS usually produces AIDS dementia complex.

o The pathology associated with AIDS related congnitive motor complex sometimes called subacute encephalitis is located mainly in subcortical areas with relative sparing of cerebral cortex.

Microscopic changes include :

  • Diffuse white matter pallor
  • Perivascular infiltrates of lymphocytes and macrophages.

o Foci of necrosis, gliosis and/or demyelination

o Microglial nodules, macrophages and multinucleated cells.

Remember,

Vasculitis is characteristically absent in CNS involvement in AIDS.

Spinal cord involvement in AIDS

o The spinal cord involvement in AIDS leads to vacuolar myelopathy. This change consists of white matter

vacuolation in posterior and lateral column and is mainly due to swelling within myelin sheaths.

o Involvement of posterior column gives symptoms similar to subacute combined degeneration of cord (Vit B12

deficiency).



Q. 10

Histopathological feature of HIV encephalitis is/are­

 A

Negri body

 B

Lewy body

 C

Fibrillary plaque

 D

Microglial nodules

Q. 10

Histopathological feature of HIV encephalitis is/are­

 A

Negri body

 B

Lewy body

 C

Fibrillary plaque

 D

Microglial nodules

Ans. D

Explanation:

Ans. is ‘d’ i.e., Microglial nodules

Microscopic findings of HIV encephalitis are :‑

i)           Diffuse white matter pallor

ii)         Perivascular infiltrates of lymphocytes and macrophages

iii)        Foci of necrosis, gliosis and / or demyelination

iv)     Microglial nodules, macrophages and multinucleated cells


Q. 11

Pathologic features of brain in AIDS are all, except-

 A

Perivascular giant cell invasion

 B

Microglial nodules

 C

Vasculitis

 D

Temporal lobe infarction

Q. 11

Pathologic features of brain in AIDS are all, except-

 A

Perivascular giant cell invasion

 B

Microglial nodules

 C

Vasculitis

 D

Temporal lobe infarction

Ans. C

Explanation:

Ans. is ‘c’ i.e., Vasculitis

Other characteristic pathologic feature of CNS in AIDS are :

o Diffuse and focal spongiform changes

  • Vacuolar myelopathy of post column of spinal cord.

o Major cells affected are macrophages and monocytes.

o Most characteristic finding is chronic inflammatory reaction with widely distributed infiltrates of microglial nodules.

  • “Unlike most other viral encephalitides, HIV does not seem to infect neurons and perivasculitis is conspicuously absent”  – page 2728, 10″le ANDERSON pathology.
  • “Characteristic multinuclear Giant Cells of macrophage origin are seen in deep white matter of frontal and temporal lobes particularly in perivascular location”

Q. 12

Perivascular lymphocytes & microglial nodules are seen in –

 A

Multiple sclerosis

 B

HIV encephalitis

 C

CMV meningitis

 D

Bacterial meningitis

Q. 12

Perivascular lymphocytes & microglial nodules are seen in –

 A

Multiple sclerosis

 B

HIV encephalitis

 C

CMV meningitis

 D

Bacterial meningitis

Ans. B

Explanation:

Ans. is ‘b’ i.e., HIV encephalitis

o Perivascular infiltrate of lymphocytes (and macrophages) with microglial nodules is seen in HIV encephalitis.

o Perivascular infiltrate of lymphocytes (and monocytes) is also seen in multiple sclerosis. But, microglial nodules

are characteristic of HIV encephalitis.


Q. 13

Most common CNS neoplasm in HIV patient ‑

 A

Meduloblastoma

 B

Astrocytoma

 C

Primary CNS lymphoma

 D

Ependymoma

Q. 13

Most common CNS neoplasm in HIV patient ‑

 A

Meduloblastoma

 B

Astrocytoma

 C

Primary CNS lymphoma

 D

Ependymoma

Ans. C

Explanation:

Ans. is `c’ i.e., Primary CNS lymphoma

o Primary CNS lymphoma accounts for 2% of extranodal lymphomas and 1% of intracranial tumors.

o It is the most common CNS neoplasm in immunosuppressed patients, including those with AIDS and immunosuppression after transplantation.


Q. 14

Infection with HIV is associated with atrophy in all of the following parts of the brain except –

 A

Anterior cingulate gyms

 B

Caudate nucleus

 C

Lower white matter volume

 D

Globus pallidus

Q. 14

Infection with HIV is associated with atrophy in all of the following parts of the brain except –

 A

Anterior cingulate gyms

 B

Caudate nucleus

 C

Lower white matter volume

 D

Globus pallidus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Anterior cingulate gyrus

HIV -1 associated neuronopathy is characterized by

         The infiltration of macrophages into the CNS.

         The formation of microglial nodule and multinucleated giant cell which result possibly from virus induced fusion of microglia and/macrophages in central white or gray matter

         Astrocyte activation and damage, neuronal loss particularly in

                                              Hippocampus

                                              Basal ganglia

                                              Caudate nucleus.

o In addition a variable degree of white matter pathology with evidence of broad range of myelin damage ranging from pallor to widespread breakdown and loss leading to accumulation of lipid macrophages in extreme cases with axonal damage in the latter cases, and the presence of HIV-1 in the cerebrospinal spinal ,fluid (CSF) has been reported..


Q. 15

All are true regarding Primary CNS lymphoma except

 A

Radiotherapy and chemotherapy is of no value

 B

Occurs in AIDS pt.

 C

Commonly occurs in immuno-compromised persons

 D

EBV may be a cause

Q. 15

All are true regarding Primary CNS lymphoma except

 A

Radiotherapy and chemotherapy is of no value

 B

Occurs in AIDS pt.

 C

Commonly occurs in immuno-compromised persons

 D

EBV may be a cause

Ans. A

Explanation:

Ans is ‘a’ i.e. ie Radiotherapy and chemotherapy is of no value 

Primary CNS lymphoma

  • These are B cell malignancies that present within the neuraxis without evidence of systemic lymphoma.
  • They occur most frequently in immunocompromised individuals, specifically organ transplant recipients or patients with AIDS.

In immunocompromised patients CNS lymphomas are invariably associated with Epstein – Barr virus (EBV) infection of the tumor cells.

Treatment :

The prognosis of primary CNS lymphoma is poor compared to histologically similar lymphoma occurring outside the CNS.

Many patients experience a dramatic and radiographic clinical response to glucocorticoids however it inevitably relapses within weeks.

The mainstay of definitive therapy is chemotherapy including high-dose methotrexate. This is followed in patients < 60 years with radiotherapy.

The mainstay of definitive therapy is chemotherapy.

A single dose of rituximab is generally administered prior to cytotoxic chemotherapy

Chemotherapy includes high-dose methotrexate, but multiagent chemotherapy, usually adding vincristine and procarbazine, appears to be more effective than methotrexate alone.

Chemotherapy is followed in patients <60 years with whole-brain radiation therapy (WBRT). Despite aggressive therapy > 90% of patients develop recurrent CNS disease.


Q. 16

Which of the following is the most common CNS tumor associated with HIV infection?

 A

Lymphoma

 B

Glioma

 C

Astrocytoma

 D

Medulloblastoma

Q. 16

Which of the following is the most common CNS tumor associated with HIV infection?

 A

Lymphoma

 B

Glioma

 C

Astrocytoma

 D

Medulloblastoma

Ans. A

Explanation:

Answer is A (Lymphoma):

The most common neoplasm in the central Nervous System (CNS malignancy) in HIV positive patients is primary CNS Lymphoma.

‘Primary CNS Lymphoma is the most common neoplasm of the CNS in HIV positive patients’. – ‘Radiology of AIDS’ (Springer 2001)/69

Primary CNS Lymphoma is the most common CNS opportunistic malignancy in patients with HIV infection’. Spiral Manual of Allergy & Immunology 4th/439


Q. 17

Most common CNS manifestation of HIV infection is:      

March 2005

 A

Seizures

 B

Dementia

 C

Focal neurologic deficits

 D

Stroke

Q. 17

Most common CNS manifestation of HIV infection is:      

March 2005

 A

Seizures

 B

Dementia

 C

Focal neurologic deficits

 D

Stroke

Ans. B

Explanation:

Ans. B: Dementia

Multiform CNS complications accompany HIV infection.

  • The HIV-1-associated cognitive/motor complex or AIDS dementia complex (ADC), is the most severe and is considered as the AIDS defining illness.
  • Vacuolar myelopathy,
  • Certain peripheral neuropathies
  • CNS lymphoma,
  • Kaposi sarcoma,
  • Progressive multifocal leukoencephalopathy (PML),
  • Cryptococcal meningitis, tuberculous meningitis etc.


Treatment Modalities In HIV/AIDS Patients

Treatment Modalities In HIV/AIDS Patients

Q. 1

Drug of choice for diarrhea in AIDS is?

 A Loperamide
 B

Lactulose

 C Octreotide
 D

Codeine

Q. 1

Drug of choice for diarrhea in AIDS is?

 A Loperamide
 B

Lactulose

 C Octreotide
 D

Codeine

Ans. C

Explanation:

Octreotide

REF: Goodman and Gillman 11th ed p. 635

Octreotide inhibits the release of hormones (triggered by rapid passage of food into the small intestine) that are responsible for distressing local and systemic effects.

Octreotide has been used, with varying success, in other forms of secretory diarrhea such as

  1. Chemotherapy-induced
  2. Diarrhea associated with human immunodeficiency virus (HIV)
  3. Diabetes-associated diarrhea.
  4. Its greatest utility is in the “dumping syndrome” seen in some patients after gastric surgery and pyloroplasty

Q. 2

Which is a glycoprotein, produced by many mammalian cells, and used in the treatment of hepatitis, papillomaviruses, hairy-cell leukemia and AIDS-related Kaposi’s sarcoma?

 A

Interferon

 B

Idoxuridine

 C

Zidovudine

 D

Zalcitabine

Q. 2

Which is a glycoprotein, produced by many mammalian cells, and used in the treatment of hepatitis, papillomaviruses, hairy-cell leukemia and AIDS-related Kaposi’s sarcoma?

 A

Interferon

 B

Idoxuridine

 C

Zidovudine

 D

Zalcitabine

Ans. A

Explanation:

All the above agents are synthetic analogues, except Interferon which is a glycoprotein produced by many types of mammalian cells.

It has been shown to be useful in treatment of hepatitis, papillomaviruses, hairy-cell leukemia and AIDS-related Kaposi’s sarcoma.
Idoxuridine, as its name implies, is a synthetic pyrimidine analog, which inhibits viral DNA polymerase.
Zidovudine and zalcitabine are also synthetic pyrimidine analogs but they inhibit reverse transcriptase and act as chain terminators.
Ref: Baden L.R., Dolin R. (2012). Chapter 178. Antiviral Chemotherapy, Excluding Antiretroviral Drugs. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

Q. 3

Which among the following is not true about Octreotide?

 A

Somatostatin analogue

 B

Used in secretory diarrhea in AIDS

 C

Used in carcinoid

 D

An absorbent

Q. 3

Which among the following is not true about Octreotide?

 A

Somatostatin analogue

 B

Used in secretory diarrhea in AIDS

 C

Used in carcinoid

 D

An absorbent

Ans. D

Explanation:

Octreotide is an octapeptide analog of somatostatin (SST) that is effective in inhibiting the severe secretory diarrhea brought about by hormone-secreting tumors of the pancreas and the GI tract. Its mechanism of action appears to involve inhibition of hormone secretion, including 5-HT and various other GI peptides (e.g., gastrin, vasoactive intestinal polypeptide (VIP), insulin, secretin, etc.). Octreotide has been used off label, with varying success, in other forms of secretory diarrhea such as chemotherapy-induced diarrhea, diarrhea associated with human immunodeficiency virus (HIV), and diabetes-associated diarrhea. Its greatest utility, however, may be in the “dumping syndrome” seen in some patients after gastric surgery and pyloroplasty.
A long-acting preparation of octreotide acetate enclosed in biodegradable microspheres is available for use in the treatment of diarrheas associated with carcinoid tumors and VIP–secreting tumors, as well as in the treatment of acromegaly.
 
Ref :Sharkey K.A., Wallace J.L. (2011). Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e.

Q. 4

 All of the following statements regarding Octreotide is TRUE, EXCEPT:

 A

It is a somatostatin analogue

 B

Used in secretory diarrhea in AIDS

 C

Used in carcinoid

 D

An absorbent

Q. 4

 All of the following statements regarding Octreotide is TRUE, EXCEPT:

 A

It is a somatostatin analogue

 B

Used in secretory diarrhea in AIDS

 C

Used in carcinoid

 D

An absorbent

Ans. D

Explanation:

Octreotide is an octapeptide analog of somatostatin. It acts by inhibiting hormone secretion such as 5HT and other GI peptides. 

Indications:
  • It is effectively used in treating severe secretory diarrhea brought about by hormone-secreting tumors of the pancreas and the GI tract.
  • It is also used off label in the treatment of secretory diarrhea such as chemotherapy-induced diarrhea, diarrhea associated with HIV and diabetes-associated diarrhea.
  • It is also used in dumping syndrome  seen in some patients after gastric surgery and  pyloroplasty. In this condition, octreotide inhibits the release of hormones that are responsible for distressing local and systemic effects.
Ref: Sharkey K.A., Wallace J.L. (2011). Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease. In B.C. Knollmann (Ed), Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e.

Q. 5

Octreotide is, except –

 A

Somatostatin analogue

 B

Used in refractory diarrhoea in AIDS

 C

Used in carcinoid

 D

An absorbent

Q. 5

Octreotide is, except –

 A

Somatostatin analogue

 B

Used in refractory diarrhoea in AIDS

 C

Used in carcinoid

 D

An absorbent

Ans. D

Explanation:

Ans. is ‘d’ i.e., An absorbent


Q. 6

Integrase inhibitors approved for HIV is:

 A

Raltegravir

 B

Indinavir

 C

Lopinavir

 D

Elvitegravir

Q. 6

Integrase inhibitors approved for HIV is:

 A

Raltegravir

 B

Indinavir

 C

Lopinavir

 D

Elvitegravir

Ans. A

Explanation:

Ans. is ‘a’ i.e., Raltegravir

o Raltegravir is an integrase inhibitor which is used in combination with other antiretroviral agents in treatment of patients with ongoing HIV-1 replicaiton.

o Elvitegravir is also an integrase inhibitor. But it is in phase-3 trial (not approved).


Q. 7

The drug efavirenz inhibits?

 A

HIV 1 Protease

 B

HIV 1 reverse transcriptase

 C

HIV1 Integrase

 D

HIV entry into cell

Q. 7

The drug efavirenz inhibits?

 A

HIV 1 Protease

 B

HIV 1 reverse transcriptase

 C

HIV1 Integrase

 D

HIV entry into cell

Ans. B

Explanation:

 Ans is ‘b’ i.e. HIV1 reverse transcriptase

  • Efavirenz is a non-nucleoside reverse transcriptase inhibitor.

Q. 8

All of the following are anti HIV agents except ‑

 A

Ritonavir

 B

Acyclovir

 C

Didanosine

 D

Zidovudine

Q. 8

All of the following are anti HIV agents except ‑

 A

Ritonavir

 B

Acyclovir

 C

Didanosine

 D

Zidovudine

Ans. B

Explanation:

Ans. is ‘b’ i.e., Acyclovir


Q. 9

Dineshbhali Shah suffering from AIDS is on Zidovudine, lamivudine and Indnavir therapy. He develops pulmonary tuberculosis for which treatment is to be started. Which of the following should be avoided in him?

 A

Rifampicin

 B

INH

 C

Ethambutol

 D

Pyrazinamide

Q. 9

Dineshbhali Shah suffering from AIDS is on Zidovudine, lamivudine and Indnavir therapy. He develops pulmonary tuberculosis for which treatment is to be started. Which of the following should be avoided in him?

 A

Rifampicin

 B

INH

 C

Ethambutol

 D

Pyrazinamide

Ans. A

Explanation:

Ans. is ‘a’ i.e., Rifampicin

Rifampicin induces metabolism of ritonavir, indinavir and saquinavir, thus it should not be used with these drugs. Rifabutin can be used.


Q. 10

The following anti T.B. drug should not be given to AIDS patient-

 A

The following anti T.B. drug should not be given to AIDS patient-

 B

Ethambutol

 C

Streptomycin

 D

Pyrazinamide

Q. 10

The following anti T.B. drug should not be given to AIDS patient-

 A

The following anti T.B. drug should not be given to AIDS patient-

 B

Ethambutol

 C

Streptomycin

 D

Pyrazinamide

Ans. A

Explanation:

Ans. is ‘a’ i.e., Rifampicin.

Use of HIV treatment along with Anti-TB medication:


Q. 11

False about protease inhibitors in HIV is –

 A

They are powerful enzyme inhibitors

 B

Of all the protease inhibitors saquinavir is the most powerful inhibitor of CYP3A4

 C

They cause hepatotoxicity

 D

All protease inhibitors are substrates for P glycoprotein coded by MDR gene.

Q. 11

False about protease inhibitors in HIV is –

 A

They are powerful enzyme inhibitors

 B

Of all the protease inhibitors saquinavir is the most powerful inhibitor of CYP3A4

 C

They cause hepatotoxicity

 D

All protease inhibitors are substrates for P glycoprotein coded by MDR gene.

Ans. B

Explanation:

Ans. is ‘b’ i.e., Of all protease inhibitors saquinavir is the most powerful inhibitor of CYP3A4

“Saquinavir is a weak inhibitor of CYP3A4”.
About other options

  • All protease inhibitors (especially ritonavir and lopinavir) are potent inhibitors of CYP3A4 – Ritonavir has the most pronounced inhibitory effect, while saquinavir has the least.

o Most HIV protease inhibitors are substrates for P-glycoprotein drug transporter (P-gp), which is an efflux pump encoded by the mdr 1 gene.   Goodman & Gilman 1 lth/e 1297

  • Indinavir and atazanavir can cause indirect hyperbilirubinemias with overt jaundice.

Q. 12

Zidovudine given for HIV in preganancy because –

 A

Decreases the risk of vertical transmission

 B

Decrease severity of infection in mother

 C

Decrease severtiy of infection in newborn

 D

Causes no benefit

Q. 12

Zidovudine given for HIV in preganancy because –

 A

Decreases the risk of vertical transmission

 B

Decrease severity of infection in mother

 C

Decrease severtiy of infection in newborn

 D

Causes no benefit

Ans. A

Explanation:

Ans. is ‘a’ i.e., Decreases the risk of vertical transmission

Treatment during Pregnancy

  • HIV infected mother can transmit the virus to fetus/infant during pregnancy, during delivery or by breast feeding. o Early diagnosis and antiretroviral therapy to mother and infant significantly decrease the rate of intrapartum and perinatal transmission (vertical transmission) of HIV infection.

o Zidovudine treatment of HIV infected pregnant women from the beginning of second trimester through delivery and of infant for 6 weeks following birth decreases the rate of transmission from 22.6% to < 5%.

o Single dose of nevirapine given to the mother at the onset of labor followed by a single dose to the newborn within 72 hours of birth decreased transmission by 50%. This is the prefered regimen now in developing countries.

Treatment of HIV infection in general (HAART)

o It includes 3 or more drugs, of which one or two are always NRTIs.

o The combination may be 2 NRITs + 1 protease inhibitor or 1NRITs + 1NNRITs + 1PI.

For prophylaxis a combination of two NRTIs (regimen A) or a combination of two NRITs plus a protease inhibitor (regimen B) may be used – regimen B is preffered.


Q. 13

Drugs safe in pregnancy with HIV infection is ‑

 A

Zidovudine

 B

Indinavir

 C

Lamivudine

 D

All of the above

Q. 13

Drugs safe in pregnancy with HIV infection is ‑

 A

Zidovudine

 B

Indinavir

 C

Lamivudine

 D

All of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., All of the above

Antiretroviral agents in pregnancy

Recommended                       Alternative

NRTIs

o Zidovudin                            o Diadanosine

o Lamivudine                         o Emtricitabine

o Stavudine

o Abacavir

NNRTIs

o Nepirapine

Pis

o Nelfinavir                             o Indinavir

o Squinavir                             o Lopinavir/ritonavir


Q. 14

A month old HIV positive child following URTI developed sudden onset of breathlessness. The chest x-ray shows hyperinflation. The O2 saturation was greater than 90%. The treatment of choice is –

 A

Cotrimoxazole

 B

Ribavarin

 C

N Ganciclovir

 D

Nebulized Acyclovir

Q. 14

A month old HIV positive child following URTI developed sudden onset of breathlessness. The chest x-ray shows hyperinflation. The O2 saturation was greater than 90%. The treatment of choice is –

 A

Cotrimoxazole

 B

Ribavarin

 C

N Ganciclovir

 D

Nebulized Acyclovir

Ans. B

Explanation:

Ans. is ‘b’ i.e., Ribavarin

o The child with HIV is suffering from Bronchiolitis.

o Antibiotics are not usually used in the treatment ofBronchiolitis who are previously healthy but Ribavarin shortens the duration of treatment in patient who have —> Immunodeficiency, Congenital heart disease, Chronic lung disease o The child in the question is having immunodeficiency due to, HIV infection. Therefore Ribavarin should be used in the treatment of this patient.


Q. 15

For the prevention of parent to child transmission of HIV, the NACO’s recommendation is to give –

 A

Niverapine 200 mg in active labour to mother

 B

Niverapine 200 mg, four hours after rupture to membranes, to mother

 C

Niverapine 200 mg in active about to mother and syrup niverapine 2 mg/kg body weight to newborn with 72 hours of delivery

 D

Syrup niverapine 2 mg/kg body weight to newborn within 72 hours of birth

Q. 15

For the prevention of parent to child transmission of HIV, the NACO’s recommendation is to give –

 A

Niverapine 200 mg in active labour to mother

 B

Niverapine 200 mg, four hours after rupture to membranes, to mother

 C

Niverapine 200 mg in active about to mother and syrup niverapine 2 mg/kg body weight to newborn with 72 hours of delivery

 D

Syrup niverapine 2 mg/kg body weight to newborn within 72 hours of birth

Ans. C

Explanation:

Ans. is ‘c’ i.e., Niverapine 200 mg in active about to mother and syrup niverapine 2 mg/kg body weight to newborn within 72 hours of delivery


Q. 16

An AIDS patient presents with fistula – in- ano. His CD4 count is below 50. What is the treatment of choice –

 A

Seton

 B

Fistulectomy

 C

None

 D

Both

Q. 16

An AIDS patient presents with fistula – in- ano. His CD4 count is below 50. What is the treatment of choice –

 A

Seton

 B

Fistulectomy

 C

None

 D

Both

Ans. A

Explanation:

Ans. is ‘a’ i.e., Seton


Q. 17

The drug of choice for cytomegalovirus retinitis in HIV patients: 

March 2007

 A

Acyclovir

 B

Ganciclovir

 C

Ribavarin

 D

Vidarabine

Q. 17

The drug of choice for cytomegalovirus retinitis in HIV patients: 

March 2007

 A

Acyclovir

 B

Ganciclovir

 C

Ribavarin

 D

Vidarabine

Ans. B

Explanation:

Ans. B: Ganciclovir

CMV infection is the commonest ocular infection in HIV.

Cytomegalovirus (CMV) is a DNA virus in the family Herpesviridae known for producing large cells with nuclear and cytoplasmic inclusions called an “owl’s eye” effect.

While CMV is found in almost everyone, and is usually fought off by the immune system, for people who are immunocompromised, by diseases, transplants, or chemotherapy the virus is not adequately destroyed and can cause damage to the eye and the rest of the body.

HIV positive persons are most at risk, especially when the CD4 cell count decreases.

It is usually treated by antivirals such as ganciclovir or foscarnet, which can be taken orally, intravenously, injected directly into the eye (intravitreal injection).

Ganciclovir has good antiviral property against herpes simplex virus 1 and 2, Epstein-Barr virus, and is at least 100 times

more potent an inhibitor of CMV replication in vitro than acyclovir.

Fomivirsen is the first antisense drug as an intraocular injection for the treatment of cytomegalovirus retinitis.


Q. 18

Vision loss in HIV is commonly due to infection with:

March 2005 March 2013 (h)

 A

Herpes virus

 B

Toxocara

 C

Toxoplasma

 D

Cytomegalovirus

Q. 18

Vision loss in HIV is commonly due to infection with:

March 2005 March 2013 (h)

 A

Herpes virus

 B

Toxocara

 C

Toxoplasma

 D

Cytomegalovirus

Ans. D

Explanation:

Ans. D: Cytomegalovirus

Cytomegalovirus (CMV) retinitis is a sight-threatening disease frequently associated with Acquired Immunodeficiency Syndrome (AIDS).

Patients with retinitis caused by CMV infection may be asymptomatic or may experience blurred vision, floaters, scotomata, or central or peripheral vision loss or distortion.

Retinal examination shows creamy to yellowish lesions, white granular areas with perivascular exudates, and hemorrhages (“cottage cheese and ketchup”).

The abnormalities initially appear in the periphery, but progress if untreated to involve the macula and optic disc. Vision loss is usually permanent.


Q. 19

Post exposure prophylaxis [PEP] for HIV should be given for a minimum period of: 

March 2005

 A

4 weeks

 B

6 weeks

 C

8 weeks

 D

10 weeks

Q. 19

Post exposure prophylaxis [PEP] for HIV should be given for a minimum period of: 

March 2005

 A

4 weeks

 B

6 weeks

 C

8 weeks

 D

10 weeks

Ans. A

Explanation:

Ans. A: 4 weeks

PEP should normally be continued for 4 weeks. This time course, or the drugs used may need to be modified if problems of tolerance and/or toxicity are encountered .Since nausea is a common problem, the prescription of prophylactic anti-emetics should be considered. Anti-motility drugs may be helpful if diarrhoea develops – a common side effect of nelfinavir. A combination of two nucleoside analogue reverse transcriptase inhibitors for less severe exposures and combination of two nucleoside analogue reverse transcriptase inhibitors and a 3rd drug for severe exposures.


Q. 20

Which drug is given as a single dose to prevent mother to child HIV transmission:         

March 2007

 A

Didanosine

 B

Nevirapine

 C

Acyclovir

 D

Nelfinavir

Q. 20

Which drug is given as a single dose to prevent mother to child HIV transmission:         

March 2007

 A

Didanosine

 B

Nevirapine

 C

Acyclovir

 D

Nelfinavir

Ans. B

Explanation:

Ans. B: Nevirapine

Majority of mother to child transmission of HIV-1 occurs during the intrapartum period.

Mechanism of vertical transmission include infection after rupture of the membranes and direct contact of the fetus with infected secretions of blood from the maternal genital tract.

Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used to treat HIV-1 infection and AIDS. It target the reverse transcriptase enzyme, an essential viral enzyme which transcribes viral RNA into DNA.

Nevirapine is not effective against HIV-2, as the pocket of the HIV-2 reverse transcriptase has a different structure, which confers intrinsic resistance to the NNRTI class.

Adverse effects

The most common adverse effect of nevirapine is the development of mild or moderate rash (13%).

Severe or life-threatening skin reactions have been observed in 1.5% of patients, including Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity.

Drug interactions

Significant lowering of nevirapine levels occurs with the anti-tuberculosis drug, rifampicin.

Nevirapine is an inducer of cytochrome P450 isoenzymes. It reduces the levels of several co-administered drugs including the antiretrovirals efavirenz, indinavir, lopinavir, nelfinavir and saquinavir, as well as clarithromycin, ketoconazole, forms of hormonal contraception, and methadone.

Preventing mother-to-child transmission

A single dose of nevirapine given to both mother and child reduced the rate of HIV transmission by almost 50% compared with a very short course of zidovudine (AZT) prophylaxis.(This 50% is the comparative reduction of HIV transmission between the two drugs)

Zidovudine administered during pregnancy and labor and to the newborn reduces the risk of vertical transmission by 70%.

Cesarean section is associated with additional risk reduction compared to vaginal delivery.


Q. 21

Which anti TB drug is avoided in HIV patient ‑

 A

INH

 B

Rifampicin

 C

Pyrazinamide

 D

Streptomycin

Q. 21

Which anti TB drug is avoided in HIV patient ‑

 A

INH

 B

Rifampicin

 C

Pyrazinamide

 D

Streptomycin

Ans. B

Explanation:

Ans. is ‘b i.e., Rifampicin

  • All HIV-infected TB patients are candidates for ART, and the optimal timing for its initiation is as soon as possible and within the first 8 weeks of anti-TB therapy.
  • Rifampin, a potent inducer of enzymes of the cytochrome P450 system, lowers serum levels of many HIV protease inhibitors and some non- nucleoside reverse transcriptase inhibitors-essential drugs used in ART.
  • In such cases, rifabutin, which has much less enzyme- inducing activity, has been recommended in place of rifampin. However, dosage adjustment for rifabutin and/or the antiret- roviral drugs may be necessary.

Q. 22

HIV integrase inhibitor is ‑

 A

Elvitegravir

 B

Abacavir

 C

Maraviroc

 D

Tenofovir

Q. 22

HIV integrase inhibitor is ‑

 A

Elvitegravir

 B

Abacavir

 C

Maraviroc

 D

Tenofovir

Ans. A

Explanation:

Ans. is ‘a’ i.e., Elvitegravir

New drugs in HIV infection

  • Etravirine is recently approved NNRTI. This is second generation NNRTI and is effective against HIV resistant to first generation NNRTI (Efavirenz, Delaviridine, Nevirapine).

Fusion inhibitors (Entry inhibitors)

  • Enfluviritide binds to Gp41 subunit of HIV envelop protein and inhibits the fusion of viral and host cell membrane.
  • Maraviroc is a CCRS Co-receptor antagonist and is only active against “CCR – 5 – tropic virus” which tends to predominate early in infection.

Integrase inhibitors

  • Raltegravir and Elvitegravir act by inhibiting enzyme integrase.


Prevention Methods In HIV

Prevention Methods In HIV

Q. 1

Gloves, syringes, needles etc., used for patients whose HIV test results is not known, should be immersed in –

 A

Povidone – iodine 1%

 B

Boiling water

 C

1% solution of sodium hypochlorite

 D

None

Q. 1

Gloves, syringes, needles etc., used for patients whose HIV test results is not known, should be immersed in –

 A

Povidone – iodine 1%

 B

Boiling water

 C

1% solution of sodium hypochlorite

 D

None

Ans. D

Explanation:

Ans. is ‘None’

. For contaminated medical instruments 2 % solution of glutaraldehyde is used.


Q. 2

All of the following strategies are effective in preventing mother to child transmission of HIV, except-

 A

Zidovudine to mother & baby

 B

Vaginal cleansing before delivery

 C

Stopping breast feeding

 D

Elective caesarean section

Q. 2

All of the following strategies are effective in preventing mother to child transmission of HIV, except-

 A

Zidovudine to mother & baby

 B

Vaginal cleansing before delivery

 C

Stopping breast feeding

 D

Elective caesarean section

Ans. B

Explanation:

Ans. is ‘b’ i.e., Vaginal cleansing before delivery 

Methods to prevent vertical transmission

a) Antiretroviral prophylaxis‑

         Vertical transmission can be prevented substantially by giving antiretroviral therapy to mother and early prophylaxis to newborn.

b) Caesaren delivery –

  • Elective caesarean section reduces the risk of transmission by 50% in women with or without ZDV treatment.

c) Breast feeding –

  • Because breast milk can carry the virus, breast feeding by HIV infected mothers is contraindicated.

         However Dutta/obs writes ‑

“In the developing world, where alternative forms of infant nutrition are not safe, minor risk associated with breast feeding may be accepted. Mother is counselled as regards the risk and benefits. She is helped to make an informed choice.”

 

HAV

HBV

HCV

HDV

BEV

o Virology

RNA

DNA

RNA

RNA

RNA

o Incubation

15-45

30-180

15-160

30-180

14-60

o Transmission

 

 

 

 

 

i) Parentral

Rare

Yes

Yes

Yes

No

ii) Feco-oral

Yes

No

No

No

Yes

iii) Sexual

No

Yes

Rare

Yes

No

iv) Perinatal

No

Yes

Rare

Yes

No

o Chronic infection

No

Yes

Yes

Yes

No

o Fulminent disease

Rare

Yes

Rare

Yes

Yes


Q. 3

A knownHIV positive patient is admitted in anisolation ward after an abdominal surgery followingan accident. The resident docter who changed hisdressing the next day found it to be soaked in blood hich of the following would be the right method ofchoice of descarding the dressing –

 A

Pour 1% hypochloric on the dressing materialand send it for incineration in a appropriate bag

 B

Pour 5% hypochlorite on the dressing materialand send it for incineration in a appropriate bag

 C

Put the dressing material directly in anappropriate bag and send for incineration

 D

Pour2% Lysol on the dressing material and sendit for incineration in a appropriate bag

Q. 3

A knownHIV positive patient is admitted in anisolation ward after an abdominal surgery followingan accident. The resident docter who changed hisdressing the next day found it to be soaked in blood hich of the following would be the right method ofchoice of descarding the dressing –

 A

Pour 1% hypochloric on the dressing materialand send it for incineration in a appropriate bag

 B

Pour 5% hypochlorite on the dressing materialand send it for incineration in a appropriate bag

 C

Put the dressing material directly in anappropriate bag and send for incineration

 D

Pour2% Lysol on the dressing material and sendit for incineration in a appropriate bag

Ans. C

Explanation:

Ans. is ‘c’ i.e., Put the dressing material directly in an appropriate bag and send for incineration

o This waste category lies in category No. 6

o No.6 category of solid wastes consists of : Items contaminated with blood and fluid containing

u Cotton dressings

Soiled plaster casts

o Linen

o Beddings

Other materials contaminated with blood

o Treatment and disposal of this category of wastes

o Incineration (There will be no chemical pretreatment prior to incineration)

 Autoclaving/microwaving


Q. 4

Target strategies in preventing the HIV transmission include the following except –

 A

Education

 B

Treatment of STD

 C

Anti-retroviral treatment

 D

Condoms

Q. 4

Target strategies in preventing the HIV transmission include the following except –

 A

Education

 B

Treatment of STD

 C

Anti-retroviral treatment

 D

Condoms

Ans. C

Explanation:

Ans. is `c’ i.e., Anti-retroviral treatment 


Q. 5

Targeted intervention for HIV is done for all except‑

 A

Commercial sex worker

 B

Migrant laborers

 C

Street children

 D

Industrial worker

Q. 5

Targeted intervention for HIV is done for all except‑

 A

Commercial sex worker

 B

Migrant laborers

 C

Street children

 D

Industrial worker

Ans. D

Explanation:

Ans. is `d’ i.e., Industrial worker 

Targeted interventiung

o The basic purpose of the targeted intervention programme is to reduce the transmission of HIV amongst the most vulnerable population.

o It combines a comprehensive and integrated approach to the vulnerable segment of population such as : ‑

o Sex workers                      o Migrant laborers         o Homosexual men

o Truckers                           o IV drug users             u Street children



Q. 6

Which one of the following strategies is aimed at AIDS control in India –

 A

Detection and treatment of AIDS cases in the community

 B

Detection and isolation of HIV infected persons in the community

 C

Immunoprophylaxis of the risk groups

 D

Community education behavioral change

Q. 6

Which one of the following strategies is aimed at AIDS control in India –

 A

Detection and treatment of AIDS cases in the community

 B

Detection and isolation of HIV infected persons in the community

 C

Immunoprophylaxis of the risk groups

 D

Community education behavioral change

Ans. D

Explanation:

Ans. is ‘d’ i.e., Community education behavioral changes 

Amongst the given option, only education and Behavioral changes is used in AIDS prevention and control policy.


Q. 7

Universal (standard) precautions to be observed by surgeons for the prevention of hospital acquire HIV infection include the following except-

 A

Wearing gloves and other barrier precaution

 B

Washing hands on contamination

 C

Handling sharp instruments with care

 D

Pre-operative screening of all patients of HIV

Q. 7

Universal (standard) precautions to be observed by surgeons for the prevention of hospital acquire HIV infection include the following except-

 A

Wearing gloves and other barrier precaution

 B

Washing hands on contamination

 C

Handling sharp instruments with care

 D

Pre-operative screening of all patients of HIV

Ans. D

Explanation:

Ans. is ‘d’ i.e., Pre-operative screening of all patient of HIV


Q. 8

In a patient of Hemophilia to be taken for dental extraction true is all, except

 A

All patients should be screened for HIV

 B

Extraction should be done under general anaesthesia and skilled anaesthetic care

 C

Factor VIII or cryoprecipitate can be needed

 D

Dose of Lignocaine required for anaesthesia is same as that for normal individuals

Q. 8

In a patient of Hemophilia to be taken for dental extraction true is all, except

 A

All patients should be screened for HIV

 B

Extraction should be done under general anaesthesia and skilled anaesthetic care

 C

Factor VIII or cryoprecipitate can be needed

 D

Dose of Lignocaine required for anaesthesia is same as that for normal individuals

Ans. B

Explanation:

Answer is B (Extraction should be done under General Anaesthesia):

‘In dentistry Surgery, General Anaesthesia is contraindicated in patients with Hemophilia’ – Lee’s


Q. 9

Anti HIV drug used for prevention of vertical transmission ‑

 A

Nevirapine

 B

Lamivudine

 C

Efavirez

 D

Tenofovir

Q. 9

Anti HIV drug used for prevention of vertical transmission ‑

 A

Nevirapine

 B

Lamivudine

 C

Efavirez

 D

Tenofovir

Ans. A

Explanation:

Ans. is ‘a’ i.e., Nevirapine

Treatment during pregnancy

  • HIV infected mother can transmit the virus to fetus/infant during pregnancy, during delivery or by breast feeding.
  • Early diagnosis and antiretroviral therapy to mother and infant significantly decrease the rate of intrapartum and perinatal transmission (vertical transmission) of HIV infection.
  • Zidovudine treatment of HIV infected pregnant women from the beginning of second trimester through delivery and of infant for 6 weeks following birth decreases the rate of transmission from 22.6% to < 5%.
  • Single dose of nevirapine given to the mother at the onset of labor followed by a single dose to the newborn within 72 hours of birth decreased transmission by 50%. This is the prefered regimen now in developing countries.


WHO clinical staging of HIV/AIDS for children with confirmed HIV infection

WHO clinical staging of HIV/AIDS for children with confirmed HIV infection

Q. 1

A 30-year-old man undergoes a lung biopsy, which shows multiple nodular lesions consisting of large epithelioid cells surrounded by lymphocytes and fibroblasts. There is an area of necrosis in the center of some nodules. Numerous acid-fast bacilli are demonstrated by Ziehl-Neelsen staining within the cytoplasm of epithelioid cells. Silver stains for fungi are negative. Which of the following is the MOST likely condition that predisposed the patient to this pulmonary disease?

 A

Acquired immunodeficiency syndrome (AIDS)

 B

Common variable immunodeficiency

 C

Cystic fibrosis

 D

Depressed level of consciousness

Q. 1

A 30-year-old man undergoes a lung biopsy, which shows multiple nodular lesions consisting of large epithelioid cells surrounded by lymphocytes and fibroblasts. There is an area of necrosis in the center of some nodules. Numerous acid-fast bacilli are demonstrated by Ziehl-Neelsen staining within the cytoplasm of epithelioid cells. Silver stains for fungi are negative. Which of the following is the MOST likely condition that predisposed the patient to this pulmonary disease?

 A

Acquired immunodeficiency syndrome (AIDS)

 B

Common variable immunodeficiency

 C

Cystic fibrosis

 D

Depressed level of consciousness

Ans. A

Explanation:

The lesion shown is a necrotizing granuloma developing as a result of infection by acid-fast bacilli (most likely mycobacteria).

Granulomatous inflammation is a specialized form of chronic inflammation, which begins with the uptake of foreign antigens by macrophages. These cells process and present the antigen to helper T lymphocytes, which in turn activate macrophages by interferon-γ secretion.

Granulomas may be due to infectious and noninfectious causes.

Usually, infectious granulomas are necrotizing and non-infectious granulomas are non-necrotizing, but there are many exceptions to this rule. Among the infectious causes, mycobacterial infections are of the utmost importance, especially in patients with AIDS.

Fungi may also cause granulomas, which may be of the necrotizing or non-necrotizing type.

By definition, however, caseating necrosis is pathognomonic of mycobacterial infection.

Also know:
Common variable immunodeficiency is one of the most common forms of congenital immune deficiency syndrome. It is due to inability of lymphocytes to mature into plasma cells. Consequently, levels of immunoglobulins are depressed, and patients suffer from depressed humoral immunity. Cell-mediated immunity (on which granuloma formation is largely dependent) is intact.
 
Cystic fibrosis predisposes to recurrent bronchopneumonia and development of bronchiectasis.
 
Depressed level of consciousness predisposes to aspiration of gastric contents and development of aspiration pneumonia.
Sheets of macrophages are often observed, but not necrotizing granulomas (unless there are additional predisposing conditions, such as AIDS).
 
Ref: Chandrasoma P., Taylor C.R. (1998). Chapter 7. Deficiencies of the Host Response. In P. Chandrasoma, C.R. Taylor (Eds), Concise Pathology, 3e. 

 


Q. 2

A 35-year-old man develops hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration. An MRI of the brain demonstrates widespread areas of abnormal T2 signal in the white matter. An electroencephalogram is remarkable for diffuse slowing over both cerebral hemispheres. Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions. This patient’s condition is most closely related to which of the following diseases?

 A

AIDS

 B

Chickenpox

 C

Measles

 D

Syphilis

Q. 2

A 35-year-old man develops hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration. An MRI of the brain demonstrates widespread areas of abnormal T2 signal in the white matter. An electroencephalogram is remarkable for diffuse slowing over both cerebral hemispheres. Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions. This patient’s condition is most closely related to which of the following diseases?

 A

AIDS

 B

Chickenpox

 C

Measles

 D

Syphilis

Ans. A

Explanation:

The condition is progressive multifocal leukoencephalopathy, which is a rapidly progressive demyelinating disorder in which the JC virus (a papovavirus) infects oligodendroglial cells in the brain.

The eosinophilic inclusions represent accumulations of JC virus. PML occurs in about 1% of AIDS patients, and is the AIDS-defining illness in half of the patients who develop the condition. There is no effective treatment for this disorder.

Shingles and post-infectious encephalitis can follow chickenpox, but varicella is not associated specifically with demyelination.
Measles can cause an encephalitis, and in some cases, subacute sclerosing panencephalitis (SSPE) may follow previous measles infection.

These disorders would affect not only white matter, but gray matter as well. Also, SSPE usually occurs before the age of 18.
 

Syphilis can cause meningitis, encephalitis, and spinal cord damage, but the disease process would not be limited to the white matter.

Q. 3

A 35 year old man develops hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration. An MRI of the brain demonstrates widespread areas of abnormal T2 signal in the white matter. An electroencephalogram is remarkable for diffuse slowing over both cerebral hemispheres. Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions. This patient’s condition is most closely related to which of the following diseases?

 A

AIDS

 B

Chickenpox

 C

Measles

 D

Syphilis

Q. 3

A 35 year old man develops hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration. An MRI of the brain demonstrates widespread areas of abnormal T2 signal in the white matter. An electroencephalogram is remarkable for diffuse slowing over both cerebral hemispheres. Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions. This patient’s condition is most closely related to which of the following diseases?

 A

AIDS

 B

Chickenpox

 C

Measles

 D

Syphilis

Ans. A

Explanation:

The condition is progressive multifocal leukoencephalopathy, which is a rapidly progressive demyelinating disorder in which the JC virus (a papovavirus) infects oligodendroglial cells in the brain.
The eosinophilic inclusions represent accumulations of JC virus.
PML occurs in about 1% of AIDS patients, and is the AIDS-defining illness in half of the patients who develop the condition.
There is no effective treatment for this disorder.
 
Shingles and post-infectious encephalitis can follow chickenpox, but varicella is not associated specifically with demyelination.
 
Measles can cause an encephalitis, and in some cases, subacute sclerosing panencephalitis (SSPE) may follow previous measles infection.
These disorders would affect not only white matter, but gray matter as well. Also, SSPE usually occurs before the age of 18.
 
Syphilis can cause meningitis, encephalitis, and spinal cord damage, but the disease process would not be limited to the white matter.
 
Ref: Brooks G.F. (2013). Chapter 44. AIDS and Lentiviruses. In G.F. Brooks (Ed),Jawetz, Melnick, & Adelberg’s Medical Microbiology, 26e.

Q. 4

M.C. psychological features of AIDS is

 A

Mania

 B

Depression

 C

Suicidal Tendency

 D

Violence

Q. 4

M.C. psychological features of AIDS is

 A

Mania

 B

Depression

 C

Suicidal Tendency

 D

Violence

Ans. B

Explanation:

B i.e. Depression

  • Depression is most common psychological feature in:
  1. AIDSQ
  2. Post partumQ/ Post myocardial infarctionQ
  3. Post surgery
  4. Myxedema
  • OCN leads to secondary depressionQ
  • Pseudo dementia & Nihilistic delusions are seen in depressionQ.

Q. 5

Which of the following is NOT a feature of HIV infection in childhood –

 A

Failure to thrive

 B

Hepatomegaly

 C

Lymphoid interstitial pneumonitis

 D

Kaposi sarcoma

Q. 5

Which of the following is NOT a feature of HIV infection in childhood –

 A

Failure to thrive

 B

Hepatomegaly

 C

Lymphoid interstitial pneumonitis

 D

Kaposi sarcoma

Ans. D

Explanation:

Ans. is ‘d’ i.e., Kaposi Sarcoma 

“Kaposi sarcoma, commonly seen in men with advanced HIV disease, has been reported only rarely in children”.

Clinical manifestations of HIV infection in children

o Failure to thrive is universal                                                       o Lymphadenopathy

o P. Carinii pneumonia M.C. AIDS defining illness in children                o Dermatological complications

o Recurrent and chronic bacterial infections (first sign).                       o Candidiasis

 Otitis, Sinusitis, Pneumonia                                                         o Lymphoid interstitial pneumonia

o Hepatosplenomegaly                                                                o Cardiomyopathy

o Anemia / Thrombocytopenia / Neutropenia                                    o Hepatitis


Q. 6

HIV in children, characteristic finding is ‑

 A

Kaposi sarcoma is common

 B

Recurrent candidiasis

 C

Recurrent chest infection

 D

Cryptococcal diarrhoea is common

Q. 6

HIV in children, characteristic finding is ‑

 A

Kaposi sarcoma is common

 B

Recurrent candidiasis

 C

Recurrent chest infection

 D

Cryptococcal diarrhoea is common

Ans. C

Explanation:

Ans. is ‘c’ i.e., Recurrent Chest infection with atypical organism 

o ” Pneumonia caused by pneumocystis carinii is the most common AIDS defining diagnosis in children with unrecognized HIV infection”


Q. 7

Teratogenic effects are rare with which of the following infections:      

September 2010

 A

CMV

 B

Rubella

 C

Varicella

 D

HIV

Q. 7

Teratogenic effects are rare with which of the following infections:      

September 2010

 A

CMV

 B

Rubella

 C

Varicella

 D

HIV

Ans. D

Explanation:

Ans. D: HIV



AIDS Control Programmes

AIDS Control Programmes

Q. 1

All are indicators of goal 6 of Millennium Development Goal, EXCEPT:

 A

HIV prevalence among women aged 15-49 years

 B

Number of children orphaned by HIV/AIDS

 C

Prevalence and death rates of tuberculosis

 D

Prevalence and death rates of malaria

Q. 1

All are indicators of goal 6 of Millennium Development Goal, EXCEPT:

 A

HIV prevalence among women aged 15-49 years

 B

Number of children orphaned by HIV/AIDS

 C

Prevalence and death rates of tuberculosis

 D

Prevalence and death rates of malaria

Ans. A

Explanation:

Ans:A.)HIV prevalence among women aged 15-49 years

Millenium Development Goals.

  • Goal 6 refers to prevention and treatment of communicable diseases which can be halted or reduced through actions for effective detection and control. Targets 6.A and 6.B refer to halting spread and treatment of HIV/ADIS while Target 6.C considers reduction of malaria and other major diseases. All three Targets include 10 indicators to measure progress made by countries by 2015.


Q. 2

Red Ribbon Express Project has been launched to promote awareness about which disease?

 A

AIDS

 B

Malaria

 C

Cervical cancer

 D

Haemophilia

Q. 2

Red Ribbon Express Project has been launched to promote awareness about which disease?

 A

AIDS

 B

Malaria

 C

Cervical cancer

 D

Haemophilia

Ans. A

Explanation:

NACO launched the Red Ribbon Express to commemorate World AIDS Day. It is a specially designed 8 coach exhibition train that will travel to 22 states covering 152 halt station during its year long journey.

Ref: Park 21st edition, page 399.
Chapter: Health programmes in India.

Q. 3

Which of the following diseases is covered under “Learning for life” training module?

 A

AIDS

 B

Tuberculosis

 C

Malaria

 D

Leprosy

Q. 3

Which of the following diseases is covered under “Learning for life” training module?

 A

AIDS

 B

Tuberculosis

 C

Malaria

 D

Leprosy

Ans. A

Explanation:

The school AIDS education is one of the important activities under National AIDS Control Programme.
A training module called Learning for life has been prepared to bring an uniformity in approach. 
 
Ref: Park 21st edition, page 399.

 


Q. 4

Which of the following is the number of national helpline for HIV/AIDS?

 A

1081

 B

1091

 C

1097

 D

1100

Q. 4

Which of the following is the number of national helpline for HIV/AIDS?

 A

1081

 B

1091

 C

1097

 D

1100

Ans. C

Explanation:

A toll free national AIDS telephone help line has been set up to provide access to information and counselling.
 
Ref: Park 21st edition, page 399.

Q. 5

National Health Policy of India-2002 includes all of the following as goals, except –

 A

Eradicated Polio and Yaws by the year 2005

 B

Achieve zero level transmission of HIV/AIDS by year 2010

 C

Eliminate Kala-azar by year 2005

 D

Eliminate Lymphatic Filariasis by year 2015

Q. 5

National Health Policy of India-2002 includes all of the following as goals, except –

 A

Eradicated Polio and Yaws by the year 2005

 B

Achieve zero level transmission of HIV/AIDS by year 2010

 C

Eliminate Kala-azar by year 2005

 D

Eliminate Lymphatic Filariasis by year 2015

Ans. C

Explanation:

Ans. is ‘c’ i.e., Eliminate kalazar by year 2005 


Q. 6

Millennium developmental goal for HIV/ AIDS ‑

 A

6

 B

3

 C

8

 D

1

Q. 6

Millennium developmental goal for HIV/ AIDS ‑

 A

6

 B

3

 C

8

 D

1

Ans. A

Explanation:

Ans. is `a’ i.e., 6 

 o Goal 6 is to combat HIV/AIDS; malaria and other diseases.



Q. 7

National AIDS control Programme was started on

 A

1977

 B

1980

 C

1987

 D

1990

Q. 7

National AIDS control Programme was started on

 A

1977

 B

1980

 C

1987

 D

1990

Ans. C

Explanation:

Ans. is ‘c’ i.e., 1987 

o National AIDS control Programme was launched in India in the year 1987.

o The Govt. of India initiated programmes of prevention and raising awareness under the medium term plan (1990-92), NACP-I ( 1992-99) and NACP-II (1999-2000).

o Based on the lessons learnt and achievements made in Phase I & Phase II, India has now developed the third National Programme Implementation plan (NACP-III, 2007-2012).

o The primary goal of NACP-III is to halt and reverse the epidemic in India over the next 5 years by integrating programmes for prevention, care, support and treatment.

o This will be achieved through 4-stages : ‑

1. Prevention of new infection in high risk groups and general population through : ‑

a)    Saturation of coverage of high risk group and targeted interventions.

b)    Scaled up interventions in the general population.

2. Providing greater care, support and treatment to a large number of people living with H1 V/AIDS.

3. Strenthening the infrastructure, system and human resources in prevention, care support and treatment programmes at the district, state and national levels.

4. Strengthening a nation-wide strategic information management system.


Q. 8

Which of t he following is not true about National AIDS Control Programme-

 A

Sentinel surveillance methodology has been adopted

 B

Community based screening for prevalence of HIV taken up

 C

Early diagnosis and treatment of STD is one of major strategy to control spread of HIV

 D

Formulating guidelines for blood banks, blood donors & dialysis units

Q. 8

Which of t he following is not true about National AIDS Control Programme-

 A

Sentinel surveillance methodology has been adopted

 B

Community based screening for prevalence of HIV taken up

 C

Early diagnosis and treatment of STD is one of major strategy to control spread of HIV

 D

Formulating guidelines for blood banks, blood donors & dialysis units

Ans. B

Explanation:

Ans. is ‘b’ i.e., Community based screening for prevalence of HIV taken up

o In April 2002, the Government of India approved the National AIDS prevention and control policy.

o The objectives included reduction of the impact of epidemic and to bring about a zero transmission rate of AIDS by year 2007.

o The components are : ‑

1. Blood safety programme

o Guidelines for blood bank, blood donors and dialysis unit have been formulated.

 The strategy is to ensure safe collection, processing, storage and distribution of blood and blood products.

Testing of every unit of blood is mandatory for -> HIV, HBV, HCV, malaria. .9philis.

o The specific objective of blood safety Programme is to ensure reduction in the transfusion associated H1V transmission to less than 0.5%.

2.   Voluntary counselling and 11 1 V testing.

3.   STD control programme

  • I-11V is transmitted more easily in the presence of another STD.
  • Hence early diagnosis and treatment of STD in now recognized as one of the major strategies to control spread of HIV infection.

4.  Condom promotion

5.  HIV surveillance -4 HIVsentinel surveillance, H1V sero-surveillance, AIDS case surveillance, STD surveillance, Behavioral surveillance.

6.  Targeted intervention    to reduce ‘he transmission of HIV amongst the most vulnerable population.

7.  School AIDS educational programme.

8, Information, education, communication and social mobilization.

9.  Family health uwarness campaign

10. Anti-retroviral treatment (ART)

Integrated counselling and Testing centres (ICICs)

More than 75% of WV infected are not aware about their status and there is a need to extend access to the counselling and testing facilites and increased demand generation.

o ICICs have been established at ‑

ti) Medical colleges                                    iii) Sub-district level hospitals

ii) District hospitals                                    iv) Community health centres.

o it is proposed to further exend the services to 24 hours PI-ICs.

o Prevention of parent to child transmission —) Women who are found to the HIV positive are given single dose of prophylactic Nevirapine at the time of labour and newborn infant is also given a single dose of nevirapine within 72 hours of birth.

o National paediatric AIDS initiatives a Provision of ART to children infected and atTected by H1V. Paediatric drugs are provided at all ART centres. Other activities are free CDH monitoring, free DNA-PCR testing for children upto 18 months, diagnosis & treatment of opportunistic infections, micronutrient supplementation, training of paediatricians and counselors.



Q. 9

Which one of the following strategies is aimed at AIDS control in India –

 A

Detection and treatment of AIDS cases in the community

 B

Detection and isolation of HIV infected persons in the community

 C

Immunoprophylaxis of the risk groups

 D

Community education behavioral change

Q. 9

Which one of the following strategies is aimed at AIDS control in India –

 A

Detection and treatment of AIDS cases in the community

 B

Detection and isolation of HIV infected persons in the community

 C

Immunoprophylaxis of the risk groups

 D

Community education behavioral change

Ans. D

Explanation:

Ans. is ‘d’ i.e., Community education behavioral changes 

Amongst the given option, only education and Behavioral changes is used in AIDS prevention and control policy.


Q. 10

“3 by 5” initiative in AIDS control programme is –

 A

Providing 3 million people treatment by end of 2005

 B

Providing treatment to 3 out of 5 patients

 C

Reducing incidence of A I DS by 3% by 2005

 D

All of the above

Q. 10

“3 by 5” initiative in AIDS control programme is –

 A

Providing 3 million people treatment by end of 2005

 B

Providing treatment to 3 out of 5 patients

 C

Reducing incidence of A I DS by 3% by 2005

 D

All of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Providing 3 million people treatment by end of 2005 

3 by 5 target

o On lst December 2003, WHO and UN A IDS announced a detailed plan to reach the “3 by 5 target” of providing antiretroviral treatment (ART) to three million people living with IIIVIAIDS in the developing countries by the end of 2005.

o Ultimate goal ()1 this strategy is to provide universal access to ART to anyone who needs it.

o It has five Pillars (focus areas of concerns) :‑

1)       Simptified standard tools to deliver ART

2)       A new service to ensure effective, reliable supply of medicines and diagnostics

3)       Dissemination and application of new knowledge and successful strategy

4)       Urgent, sustained support to countries

5)       Global leadership. backed by strong partnership


Q. 11

AIDS day is:     

September 2004

 A

7 April

 B

3 May

 C

5 June

 D

1 December

Q. 11

AIDS day is:     

September 2004

 A

7 April

 B

3 May

 C

5 June

 D

1 December

Ans. D

Explanation:

Ans. D i.e. 1 December


Q. 12

All were the goals for National health policy 2002 except: 

September 2009

 A

Eliminate lymphatic filariasis by 2015

 B

Eliminate Kala-azar by 2010

 C

Eliminate HIV by 2015

 D

Eliminate leprosy by 2005

Q. 12

All were the goals for National health policy 2002 except: 

September 2009

 A

Eliminate lymphatic filariasis by 2015

 B

Eliminate Kala-azar by 2010

 C

Eliminate HIV by 2015

 D

Eliminate leprosy by 2005

Ans. C

Explanation:

Ans. C: Eliminate HIV by 2015

The National Health Policy-2002(NHP) gives prime importance to ensure a more equitable access to health services across the social and geographical expanse of the country. It calls for a strong primary health network in rural India.

Priority has been given to preventive and curative initiatives at the primary health level through increased sectoral share of allocation

The policy envisages kick starting the revival of the Primary Health System by providing some essential drugs under Central Government funding through the decentralized health system.

Enforce a mandatory two-year rural posting before the awarding of the graduates degree.This would not only make trained medical manpower available in the underserved areas, but would offer valuable clinical experience to the graduating doctors.

Some of the goals (to be achieved by 2015) of NH p-2002 are:

  • Eliminate lymphatic filariasis by 2015
  • Eliminate Kala-azar by 2010
  • Achieve zero level growth of HIV/AIDS by 2007
  • Eliminate leprosy by 2005
  • Eradicate polio and yaws by 2005

Q. 13

In AIDs control programme, For treatment of STDs, blue colored pack is used for treatment of-

 A

Urethral discharge

 B

Scrotal swelling

 C

Genital ulcers

 D

Ano-rectal discharge

Q. 13

In AIDs control programme, For treatment of STDs, blue colored pack is used for treatment of-

 A

Urethral discharge

 B

Scrotal swelling

 C

Genital ulcers

 D

Ano-rectal discharge

Ans. C

Explanation:

Ans. is ‘c’ i.e., Genital ulcer

NACO centers providing ART (as of sept 2006)

  • The National AIDS control organization (NACO) has increased the numbers of centres providing ART from 54 to 91 centres with another 9 more centres also getting operational soon.
  • All the 9lcentres have specially appointed and trained doctors, counsellors and laboratory technicians to help initiate patients on ART and follow them regularly.
  • At these 91 centres medicines for treating 85000 patients have been made available.
  • The ART is a combination of three potent drugs, which is being given to the persons with advanced stage of AIDS.
  • Apart from providing free treatment, all the ART centres are providing counselling to the infected persons so that they maintain regularly of their medication.
  • ACO has branded the STI/RTI services as “Suraksha clinic” and has developed a communication strategy for generating demand for these services.

Q. 14

Major sign for AIDS surveillance in WHO case definition ‑

 A

> 10% weight loss

 B

Cough > 1 month

 C

Generalized lymphadenopathy

 D

Disseminated Herpes

Q. 14

Major sign for AIDS surveillance in WHO case definition ‑

 A

> 10% weight loss

 B

Cough > 1 month

 C

Generalized lymphadenopathy

 D

Disseminated Herpes

Ans. A

Explanation:

Ans. is ‘a’ i.e., > 10% weight loss

WHO case definition for AIDS surveillance

  • For the purpose of AIDS surveillance an adult or adolescent (six years of age) is considered to have AIDS if at least 2 of the following major signs are present in combination with one minor sign.

Major Signs

  • Weight loss > 10 % of body weight
  • Chronic diarrhoea for more than 1 month
  • Prolonged fever for more than 1 month

Minor signs

  • Persistent cough for more than one month
  • Generalized pruritic dermatitis
  • History of herpes zoster
  • Chronic progressive or disseminated herpes simplex infection
  • Generalized lymphadenopathy
  • Oropharyngeal Candidiasis.

Expanded WHO case definition for AIDS surveillance

  • For the purpose of surveillance on adult or adolescent (>12 years of age) is considered to have AIDS if a test for
  • HIV antibody gives a positive result and one or more of the following conditions are present :
  • >10% body weight loss or cachexia, with diarrhoea or fever or both, for at least 1 month, not known to be due to a condition unrelated to HIV infection.


Diagnostic Techniques In HIV

Diagnostic Techniques In HIV

Q. 1

All are associated with AIDS EXCEPT:

 A

Increased p 24 Ab

 B

Hypogammaglobulinemia

 C

Abnormal mitogen assay

 D

Anergy

Q. 1

All are associated with AIDS EXCEPT:

 A

Increased p 24 Ab

 B

Hypogammaglobulinemia

 C

Abnormal mitogen assay

 D

Anergy

Ans. B

Explanation:

Even though HIV causes immune suppression, it causes hypergammaglobulinemia rather than hypogammglobulinemia.

•It is associated with increased p24 antibody: basis for detection in window period.

T cell anergy is commonly seen in HIV

Abnormal response of T cells to mitogens is a test used in HIV


Q. 2

An AIDS patient develops symptoms of pneumonia, and Pneumocystis carinii is suspected as the causative organism. Bronchial lavage is performed. Which of the following stains would be most helpful in demonstrating the organism’s cysts on slides made from the lavage fluid?

 A

Alcian blue

 B

Hematoxylin and eosin

 C

Methenamine silver

 D

Prussian blue

Q. 2

An AIDS patient develops symptoms of pneumonia, and Pneumocystis carinii is suspected as the causative organism. Bronchial lavage is performed. Which of the following stains would be most helpful in demonstrating the organism’s cysts on slides made from the lavage fluid?

 A

Alcian blue

 B

Hematoxylin and eosin

 C

Methenamine silver

 D

Prussian blue

Ans. C

Explanation:

The appropriate stain is methenamine silver, and the requisition slip when submitting the wash fluid should have a reference to either Pneumocystis or methenamine silver, since routine hematoxylin and eosin does not adequately demonstrate the organisms. The cysts, when stained with methenamine silver, have a characteristic cup or boat shape; the trophozoites are difficult to demonstrate without electron microscopy. It is also worth knowing that sputum samples are not nearly as effective as bronchial washes in demonstrating the organisms.

Alcian blue is good for demonstrating mucopolysaccharides.
Hematoxylin and eosin is the routine tissue stain used in pathology laboratories. Prussian blue is good for demonstrating iron.
 

Q. 3

AIDS involves –

 A

T-helper cells

 B

T-suppressor cells

 C

T-cytotoxic

 D

B. cells

Q. 3

AIDS involves –

 A

T-helper cells

 B

T-suppressor cells

 C

T-cytotoxic

 D

B. cells

Ans. A

Explanation:

Ans. is ‘a’ i.e., Helper T Cells 

Receptors for HIV

.  The receptor for the virus is CD4 antigen, and therefore the virus may infect any cell bearing the CD4 antigen on the surface this is primarily the CD4 + (Helper) T Lymphocyte

  • Specific binding of virus to CD4 receptor is by the envelope glycoprotein gp-120. However, for infection to take place, cell fusion is essential, which is brought about by the transmembrane gp4l.

.  Entry of virus into the cells also requires coreceptor molecule :‑

T cell                                                                               CXCR4

Macrophage                                                                     CCR5


Q. 4

In diagnosis of AIDS, criteria include the following except-

 A

CD4 <200

 B

CD8 <500

 C

CD 4 : CD 8 = 1

 D

b and c

Q. 4

In diagnosis of AIDS, criteria include the following except-

 A

CD4 <200

 B

CD8 <500

 C

CD 4 : CD 8 = 1

 D

b and c

Ans. D

Explanation:

Ans. is ‘b’ i.e., CD 8 < 500; 'c' i.e., CD4 : CD8 = 1

Classification of HIV infection

.     The current CDC classification system for HIV-infected adolescents and adult categorizes persons on the basis of clinical conditions associated with HIV infection and CD-T lymphocytes.

.   The system is based on three ranges of CD4 T cell counts and three clinical categories.

.   Any HIV-infected individual with a CD4 + T Cell count of < 200/m1 has AIDS by defination, regardless of the presence of symptoms or opportunistic disease

.   Any HIV-infected individual who develops one of the HIV-associated disease of category ‘C’ has AIDS by defination (option d)

1993 Revised classification system for HIV infection and Expanded AIDS Surveillance case
Definitions for Adolescents and Adults

 

 

 

Clinical Categories

 

CD4+ T Cell

A Asymptomatic,

Acute (Primary)

B Symptomatic,

Not A or C

C AIDS-Indicator

Categories

HIV or PGI!

Conditions

Conditions

>500/m1

A 1

B I

C 1

200-499/m1

A2

B2

C2

<200/m1

A3

B3

C3

 

Clinical Categories of HIV Infection

Category A :Consists of one or more of the conditions listed below in an adolescent or adult (>13 years) with documented HIV infection. Conditions listed in categories B and C must not have occurred. Asymptomatic HIV infection

Persistent generalized lymphadenopathy

Acute (primary) HIV infection with accompanying illness or history of acute HIV infection

Category B :Consists of symptomatic conditions in an HIV infected adolescent or adult that are not included among conditions listed in clinical category C and that meet at least one of the following criteria (1) The conditions are attributed to HIV infection or are indicative of a defect in cell mediated immunity : or (2) the conditions are considered by physician to have a clinical course or to require management that is complicated by HIV infection. Examples include, but are not limited to the following

Bacillary angiomatosis

Candidiasis, oropharyngeal (thrush)

Constitutional symptoms, such as fever (38.5°C) or diarrhea lasting month

Hairy leukoplakia, oral


Q. 5

Chemokine co-receptor for HIV found on macrophage is –

 A

CD4

 B

CDS

 C

CCR5

 D

CXCR4

Q. 5

Chemokine co-receptor for HIV found on macrophage is –

 A

CD4

 B

CDS

 C

CCR5

 D

CXCR4

Ans. C

Explanation:

Ans. is ‘c’ i.e., CCR5


Q. 6

During the Window period of patient with AIDS ‑

 A

ELISA is – ye

 B

Western Blot is – ye

 C

Both are – ye

 D

PCR is – ve

Q. 6

During the Window period of patient with AIDS ‑

 A

ELISA is – ye

 B

Western Blot is – ye

 C

Both are – ye

 D

PCR is – ve

Ans. C

Explanation:

Ans. is ‘c’ i.e. Both are (-) ye


Q. 7

Window period in HIV is from –

 A

Infection to appearance of antibodies in serum

 B

Infection to appearance of viral particles in blood

 C

Infection to appearance of symptoms

 D

Infection to decrease of CD4 lymphocytes

Q. 7

Window period in HIV is from –

 A

Infection to appearance of antibodies in serum

 B

Infection to appearance of viral particles in blood

 C

Infection to appearance of symptoms

 D

Infection to decrease of CD4 lymphocytes

Ans. A

Explanation:

Ans. is ‘a’ i.e., Infection to appearance of antibodies in serum

. The seronegative infective stage, from infection to appearance of antibodies, is called as the window period.


Q. 8

p24 antigen disappears from the blood after how many weeks in HIV –

 A

2-4 weeks

 B

4-6 weeks

 C

6-8 weeks

 D

8-10 weeks

Q. 8

p24 antigen disappears from the blood after how many weeks in HIV –

 A

2-4 weeks

 B

4-6 weeks

 C

6-8 weeks

 D

8-10 weeks

Ans. C

Explanation:

Ans. is ‘c’ i.e., 6-8 week

. Low level of circulating HIV-1 p24 antigen can be detected in the plasma by EIA soon after infection.

. The antigen often becomes undetectable after antibodies develop (6-12 weeks following infection).

. p-24 antigen reappear late in the course of infection indicating a poor prognosis.


Q. 9

In HIV infected individual Gram stain of lung aspirate shows yeast like morphology. All of the following are the most likely diagnosis except ‑

 A

Candida tropicalis

 B

Cryptococcus neoformans

 C

Pencillium marneffi

 D

Aspergillus fumigates

Q. 9

In HIV infected individual Gram stain of lung aspirate shows yeast like morphology. All of the following are the most likely diagnosis except ‑

 A

Candida tropicalis

 B

Cryptococcus neoformans

 C

Pencillium marneffi

 D

Aspergillus fumigates

Ans. D

Explanation:

Ans. is `d’ i.e., Aspergillus fumigates

In this question the positive organism should fulfill the following two criteria:

Causes lung infection in immunocompromised individual

The organism should have a yeast like morphology

Among the organism mentioned in the question Aspergillus fumigatus does not fulfill the above mentioned criterias.

–                     It causes lung infection in immunocompromised patient but it does not occur in yeast like form. Microscopic appearance ofAspergillus fumigatus:

–                     Non pigmented septate mycelium with characteristic dichotomous branching and an irregular outline. All the other fungi mentioned in the question occur in yeast like form.

Penicillium marneffi (Greenwood micro 16th/e p. 588, Jawetz 22″d/e p. 555)

.                       It is a dimorphic fungus

.                       It forms yeast like cells that are often intracellular resembling histoplasmosis

.                       It causes systemic infections in AIDS patients in Asia

Candida tropicalis (Anantnarayan Th/e p. 617)

.     All candida species can occur in yeast like form

.    Bronchopulmonary candidiasis can occur as a rare complication of preexisting pulmonary or systemic disease. Crvptococcus neoformans

.    Microscopy reveals capsulated yeasts

It can cause lung infection in AIDS patient.


Q. 10

Rapid progression of disease with full blown manifestation in AIDS occurs when T4 cell count falls bellow-

 A

1000/microL

 B

500/microL

 C

200/microL

 D

50/microL

Q. 10

Rapid progression of disease with full blown manifestation in AIDS occurs when T4 cell count falls bellow-

 A

1000/microL

 B

500/microL

 C

200/microL

 D

50/microL

Ans. C

Explanation:

Ans. is ‘c’ i.e., 200/micro L

Rapid progression of disease with full blown manifestation in AIDS occurs when CD4 T cell count falls below 200/ L


Q. 11

All of the following methods are used for the diagnosis of HIV infection in a 2 month old child, except

 A

DNA-PCR

 B

Viral culture

 C

HIV ELISA

 D

p24 antigen assay

Q. 11

All of the following methods are used for the diagnosis of HIV infection in a 2 month old child, except

 A

DNA-PCR

 B

Viral culture

 C

HIV ELISA

 D

p24 antigen assay

Ans. C

Explanation:

Ans. is ‘c’ i.e., HIV Elisa 

Diagnosis of HIV in Infant

o In adults HIV can be easily diagnosed by detecting IgG antibody to HIV (Elisa and western blot test). But this method is not helpful in case of neonates because all neonates born to HIV infected mothers will have IgG antibody in their blood, regardless of infection status in them. These antibodies are passively transferred to the newborns from their mothers (IgG can cross placenta). These infants continue to test positive for IgG antibodies for upto 18 months. At the end of 18 month they will lose these antibodies so uptil 18 month of age this method of diagnosis cannot be used.

o The presence of IgA or IgM anti HIV in the infant’s blood can indicate HIV infection, because these classes of

antibodies do not cross the placenta. However detectable quantities of IgA antibodies are detected only after 3

months of life and detection of IgM antibodies is very unreliable (both insensitive and nonspecific). o So direct viral detection assays are used for the diagnoses of HIV in newborn. These are

1)       detection of HIV DNA or RNA by PCR.      3) HIV p24 antigen

2)       HIV culture                                       4) Immune complex dissociated p24 antigen.

These are very useful in young infants allowing a definitive diagnosis in most infected infants by 1 — 6 months of age. Out of these method detection of viral DNA by PCR is the preferred method in developed countries.


Q. 12

Which positive test does not necessarily indicate HIV infection in a newborn?

 A

ELISA for HIV lgG antibody

 B

p24 antigen

 C

Virus culture

 D

ELISA for HIV lgA antibody

Q. 12

Which positive test does not necessarily indicate HIV infection in a newborn?

 A

ELISA for HIV lgG antibody

 B

p24 antigen

 C

Virus culture

 D

ELISA for HIV lgA antibody

Ans. A

Explanation:

Ans. is ‘a’ i.e., ELISA for HIV lgG antibody


Q. 13

According to CDC recommendations, HIV screening of pregnant women is – 

 A

Opt in testing

 B

Opt out testing

 C

Compulsory

 D

Symptomatic

Q. 13

According to CDC recommendations, HIV screening of pregnant women is – 

 A

Opt in testing

 B

Opt out testing

 C

Compulsory

 D

Symptomatic

Ans. B

Explanation:

Ans. is ‘b’ i.e., Opt out testing


Q. 14

Lymph node biopsy of an AIDS patient shows:

March 2009

 A

Warthin-Finkeldey cells

 B

Marked follicular hyperplasia

 C

‘Moth-eaten appearance’

 D

All of the above

Q. 14

Lymph node biopsy of an AIDS patient shows:

March 2009

 A

Warthin-Finkeldey cells

 B

Marked follicular hyperplasia

 C

‘Moth-eaten appearance’

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

Histopathology of HIV

  • Florid reactive hyperplasia-may be:

–           Collections of monocytoid B cells in sinuses

–           Neutrophils

–           Features of dermatopathic lymphadenopathy

  • Often reactive germinal centers show ‘follicle lysis’:i.e. invagination of mantle lymphocytes into germinal centers associated with:

–           Disruption of centers (‘moth-eaten appearance’)

–           Distinctive clustering of large follicular center cells resulting appearance termed explosive follicular hyperplasia

  • Occasional polykaryocytes:

–           Warthin-Finkeldey cells

–           May be multinucleated form of follicular dendritic cell

  • Electron microscopy:

–           Sometimes prominent follicular dendritic cells exhibit alterations of their fine processes

Interfollicular tissue may show prominent vascular proliferation: vague resemblance to Castleman’s disease

–           These areas and subcapsular region may reveal earliest signs of Kaposi’s sarcoma

–           Sometimes advanced lymphocyte depletion: may be abnormal (regressively transformed) germinal centers


Q. 15

Best laboratory test to diagnose HIV infection

March 2007

 A

ELISA

 B

Western blot

 C

Complement fixation test

 D

RIA

Q. 15

Best laboratory test to diagnose HIV infection

March 2007

 A

ELISA

 B

Western blot

 C

Complement fixation test

 D

RIA

Ans. B

Explanation:

Ans. B: Western blot


Q. 16

Screening test for HIV infection in a patient prior to the development of antibodies (in window period):

March 2013

 A

ELISA

 B

Western blot

 C

p24 antigen

 D

All of the above

Q. 16

Screening test for HIV infection in a patient prior to the development of antibodies (in window period):

March 2013

 A

ELISA

 B

Western blot

 C

p24 antigen

 D

All of the above

Ans. C

Explanation:

Ans. C i.e. p24 antigen.

HIV infection is identified either by the detection of HIV-specific antibodies in serum or plasma or by demonstrating the presence of the virus by nucleic acid detection using polymerase chain reaction (PCR), p24 antigen testing or, rarely these days, by growing virus in cell culture.

Antibody testing is the method most commonly used to diagnose HIV infection. With the highly sensitive HIV-1/HIV-2 enzyme immunoassay (EIA) tests currently on the market, seroconversion can be detected within two to three weeks of infection in the majority of cases.

In a small number of early seroconverters who are still in the ‘window period’, the p24 antigen may become positive before antibody is detectable.


Q. 17

Average incubation period of AIDS is:     

March 2011

 A

1 year

 B

3 years

 C

5 years

 D

10 years

Q. 17

Average incubation period of AIDS is:     

March 2011

 A

1 year

 B

3 years

 C

5 years

 D

10 years

Ans. D

Explanation:

Ans. D : 10 years

The median interval from infection to the development of symptoms is around 7-10 years, although subgroups of patients exhibit ‘fast’ or ‘slow’ rates of progression.


Q. 18

In tuberculosis in an AIDS patient the chest X-ray looks like:

 A

Miliary shadow

 B

Cavity

 C

Consolidation

 D

Collapse

Q. 18

In tuberculosis in an AIDS patient the chest X-ray looks like:

 A

Miliary shadow

 B

Cavity

 C

Consolidation

 D

Collapse

Ans. A

Explanation:

Ans. Miliary shadow


Q. 19

Window period in HIV infection ‑

 A

1-2 weeks

 B

4-8 weeks

 C

8-12 weeks

 D

> 12 weeks

Q. 19

Window period in HIV infection ‑

 A

1-2 weeks

 B

4-8 weeks

 C

8-12 weeks

 D

> 12 weeks

Ans. B

Explanation:

Ans. is ‘b ‘ i.e., 4-8 weeks

Window period

  • It takes 2-8 weeks to months for antibodies to appear after infection. This period, from infection to appearance of antibodies, is called as window period.
  • During this period patients is seronegative i.e. serological tests (ELISA and Western blot) are negative. o The individual may be highly infectious during this period.


Replication & Transmission Of HIV

Replication & Transmission Of HIV

Q. 1

During the asymptomatic latent phase of AIDS, the virus is actively proliferating, and can be found in association with?

 A

B lymphocytes

 B

Follicular dendritic cells in lymph nodes

 C

Ganglion cells

 D

Oligodendrocytes

Q. 1

During the asymptomatic latent phase of AIDS, the virus is actively proliferating, and can be found in association with?

 A

B lymphocytes

 B

Follicular dendritic cells in lymph nodes

 C

Ganglion cells

 D

Oligodendrocytes

Ans. B

Explanation:

Follicular dendritic cells in the germinal centers of lymph nodes are important
reservoirs of HIV. Although some follicular dendritic cells are infected with HIV, most viral particles are found on the surface of their dendritic processes.
Follicular dendritic cells have receptors to the Fc portion of immunoglobulins that serve to trap HIV virions coated with anti-HIV antibodies.
These coated HIV particles retain the ability to infect CD4+ T cells as they traverse the dendritic cells.

 

B lymphocytes have a surface marker (CD21 protein-a complement receptor) to which an Epstein-Barr envelope glycoprotein can bind. The virus associates with the host cell genome, producing a latent infection. These B cells undergo polyclonal activation and proliferation.
 
Ganglion cells, particularly the satellite cells around the ganglion cells in the dorsal root ganglia, can be infected by varicella-zoster. Herpes type I and II infect neurons that innervate skin and mucous membranes.
 
Oligodendrocytes are directly infected by two viruses, JC virus (a polyomavirus) and measles virus. JC virus causes progressive multifocal leukoencephalopathy (PML), and measles virus produces a latent syndrome called subacute sclerosing panencephalitis (SSPE).
 
Ref: Levinson W. (2012). Chapter 58. Cellular Basis of the Immune Response. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.

Q. 2

Latency seen in viral infections-

 A

HSV-II

 B

CMV

 C

HIV

 D

All

Q. 2

Latency seen in viral infections-

 A

HSV-II

 B

CMV

 C

HIV

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., HSV – H ‘b’ i.e., CMV; ‘c’ i.e., HIV 

Measles                                  Edmonston – Zagreb Strain

Rubella                                  RA 27/3 Strain

BOG                                       Danish 1331 Strain

Mumps                                  Jeryl – Lynn Strain

Latent infection is caused by

.         HBV                               . HIV                       . VZV                           . HHV-6, HHV-7, HHV-8 (Human Herpes Virus)

.         HCV                               . HTLV                  . Some pox viruses

.         Rabies Virus                  . HPV                     . EBV

.         Measles Virus               . HSV                      . CMV


Q. 3

In the heterosexual trnsmission of HIV

 A

There is greater risk of transmission from man to woman

 B

There is greater risk of transmission from woman to man

 C

Risk is equal in either ways

 D

HIV infection is not transmitted by heterosexual act

Q. 3

In the heterosexual trnsmission of HIV

 A

There is greater risk of transmission from man to woman

 B

There is greater risk of transmission from woman to man

 C

Risk is equal in either ways

 D

HIV infection is not transmitted by heterosexual act

Ans. A

Explanation:

Ans. is ‘a’ i.e.There is greater risk of transmission from man to woman


Q. 4

AIDS is not transmitted by –

 A

Blood transfusion

 B

Breast milk

 C

Cryoprecipitate

 D

Plasma

Q. 4

AIDS is not transmitted by –

 A

Blood transfusion

 B

Breast milk

 C

Cryoprecipitate

 D

Plasma

Ans. C

Explanation:

Ans. is ‘c’ i.e., Cryoprecipitate


Q. 5

Risk of HIV transmission is not seen with ‑

 A

Whole blood

 B

Platelets

 C

Plasma derived hepatitis B vaccine

 D

Leucocytes vaccines

Q. 5

Risk of HIV transmission is not seen with ‑

 A

Whole blood

 B

Platelets

 C

Plasma derived hepatitis B vaccine

 D

Leucocytes vaccines

Ans. C

Explanation:

Ans. is ‘c’ i.e., Plasma derived hepatitis B vaccine


Q. 6

HIV virus can be isolated from all except –

 A

Semen

 B

Saliva

 C

Blood

 D

Skin scraping

Q. 6

HIV virus can be isolated from all except –

 A

Semen

 B

Saliva

 C

Blood

 D

Skin scraping

Ans. D

Explanation:

Ans. is ‘d’ i.e., Skin scraping


Q. 7

Sero conversion in HIV Infection takes place in ‑

 A

2 weeks

 B

4 weeks

 C

9 weeks

 D

12 weeks

Q. 7

Sero conversion in HIV Infection takes place in ‑

 A

2 weeks

 B

4 weeks

 C

9 weeks

 D

12 weeks

Ans. B

Explanation:

Ans. is ‘b’ i.e., 4 weeks

. The mean time to seroconversion after HIV infection is 3-4 weeks.


Q. 8

Most common mode of transmission of HIV world wide is –

 A

Heterosexual

 B

Homosexual

 C

IV-drug abuse

 D

Contaminated blood products

Q. 8

Most common mode of transmission of HIV world wide is –

 A

Heterosexual

 B

Homosexual

 C

IV-drug abuse

 D

Contaminated blood products

Ans. A

Explanation:

Ans. is ‘a’ i.e. Heterosexual

“The most common mode of infection worldwide particularly in developing countries, is clearly heterosexual transmission.”     

                                                                                                                                 –


Q. 9

Least common mode of transmission of HIV‑

 A

Homosexual contact

 B

Heterosexual

 C

IV drug abuse

 D

Transfusion of blood products

Q. 9

Least common mode of transmission of HIV‑

 A

Homosexual contact

 B

Heterosexual

 C

IV drug abuse

 D

Transfusion of blood products

Ans. D

Explanation:

Ans. is ‘d’ i.e., Transfusion of blood product

o Homosexual or Heterosexual contact               -4 50-70%

o IV drug abuse                                                          —> 25%

o Recipient of blood and blood components       —> 1%

o Hemophiliaes receiving factor VIII or IX                    0.5%


Q. 10

Trans-placental spread is least associated with?

 A

HBV

 B

Rubella

 C

HSV

 D

HIV

Q. 10

Trans-placental spread is least associated with?

 A

HBV

 B

Rubella

 C

HSV

 D

HIV

Ans. C

Explanation:

Ans. is c i.e., HSV

o Sorry guys, all the four organisms given in options can cause transplacental spread. See following table :-

Trans-placental infection

  • Rubella
  • CMV
  • HPV B-19
  • HSV
  • HIV
  • VZV
  • HT3V & HCV
  • Vaccinia virus
  • Coxsackie virus
  • Listeria monocytogenes
  • Treponema pallidum
  • Toxoplasma gondii
  • T – cruzi
  • Plasmodium
  • TB

Intrapartum infections

  • CMV
  • HSV
  • HBV
  • HIV
  • E.coli
  • Group B streptococcus
  • Chlamydia trachomatis
  • Neisseria gonorrhoeae

Listeria monocytogenes

  • CMV is the most common cause of congenital infection.

o However, we have to choose one options. Option ‘c’ (HSV) seems best to me :‑

“Although HSV infection can cause transplacental (Pre-natal) infection; it is more appropriately considered under perinatally acquired infections (during delivory)”. Infectious neonatology
“If herpes seroconversion occurs early in pregnancy the risk of transmission to the newborn is very low. In women

who acquire genital herpes shortly before delivery, the risk of transmission is high”.                     Harrison
“Despite there inclusion in table, many viruses, including HSV and hepatitis viruses, are rarely acquired as intrauterine infections. They are typically transmitted vertically (i.e. during the delivery process”.


Q. 11

Which of the following act as a means of transmission of HIV infection in newborn-

 A

Transplacental

 B

Transfusions 

 C

Breast feeding

 D

a and c

Q. 11

Which of the following act as a means of transmission of HIV infection in newborn-

 A

Transplacental

 B

Transfusions 

 C

Breast feeding

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e., Transplacental; ‘c’ i.e., Breast feeding

Maternal-fetal / infant transmission

o Probability of transmission of HIV from mother to infant/fetus ranges from 15 to 25% in industrialized countries and from 25 to 35% in developing countries.

o HIV can be transmitted from mother to fetus/infant in the following ways :

a)In utero (During pregnancy)

b)During delivery (Perinatal) —> Most common

c)After birth by breast feeding –> Least common.

o First – born twin is more commonly infected than the second twin.

o Cesarean section results in decrease transmission to the infant.

o Vit. A deficiency increases the risk of transmission.

o The major risk factor of transmission is the presence of high maternal level of plasma viremia.


Q. 12

Most common cause of HIV infection in infant is ‑

 A

Perinatal transmission

 B

Breast milk

 C

Transplacental

 D

Umbilical cord sepsis

Q. 12

Most common cause of HIV infection in infant is ‑

 A

Perinatal transmission

 B

Breast milk

 C

Transplacental

 D

Umbilical cord sepsis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Perinatal transmission 


Q. 13

% of HIV infection in child of a HIV +ve mother is-

 A

20-30%

 B

10-20%

 C

70-80%

 D

100%

Q. 13

% of HIV infection in child of a HIV +ve mother is-

 A

20-30%

 B

10-20%

 C

70-80%

 D

100%

Ans. A

Explanation:

Ans. is ‘a’ i.e., 20-30%


Q. 14

The transmission of HIV-1 transplacentally is ‑

 A

10-20%

 B

20-30%

 C

30-40 %

 D

40-50%

Q. 14

The transmission of HIV-1 transplacentally is ‑

 A

10-20%

 B

20-30%

 C

30-40 %

 D

40-50%

Ans. C

Explanation:

Ans. is ‘c’ i.e., 30-40%.

Perinatal transmission of HIV:

  • Vertical transmission to the neonates is about 14–25%.
  • Transmission of HIV 2 is less frequent (1–4%) than for HIV 1 (15-40%).
  • Transplacental transmission occurs: 20% before 36 weeks, over 80% of transmissions occur around the time of labor and delivery.
  • Vertical transmission is more in cases with preterm birth and with prolonged membrane rupture.
  • Risks of vertical transmission is directly related to maternal viral load (measured by HIV RNA) and inversely to maternal immune status (CD4+ count).
  • Maternal anti-retroviral therapy reduces the risk of vertical transmission by 70%
  •  Breastfeeding doubles the risk of MTCT transmission (14% to 28%).

Q. 15

The commonest route of transmission of HIV from the mother to the baby is –

 A

Vertical transmission during pregancy

 B

During delivery through vagina

 C

Breast milk

 D

Constant touch and handling

Q. 15

The commonest route of transmission of HIV from the mother to the baby is –

 A

Vertical transmission during pregancy

 B

During delivery through vagina

 C

Breast milk

 D

Constant touch and handling

Ans. B

Explanation:

Ans. is ‘b’ i.e., During delivery through vagina


Q. 16

The HIV virus can be transmitted by the following routes, except –

 A

Homosexual contact

 B

Intact skin

 C

Maternofoetal

 D

Needle prick

Q. 16

The HIV virus can be transmitted by the following routes, except –

 A

Homosexual contact

 B

Intact skin

 C

Maternofoetal

 D

Needle prick

Ans. B

Explanation:

Ans. is ‘b’ i.e., Intact skin 


Q. 17

The high risk groups for transmission of HIV virus include the following except –

 A

Homosexuals

 B

Haemophiliacs

 C

Children of HIV mothers

 D

Health care workers

Q. 17

The high risk groups for transmission of HIV virus include the following except –

 A

Homosexuals

 B

Haemophiliacs

 C

Children of HIV mothers

 D

Health care workers

Ans. D

Explanation:

Ans. is ‘d’ i.e., Health care workers 

In health care workers there is small but definite risk


Q. 18

Privileged communication may be made by a doctor in:           

September 2003

 A

Notifiable diseases

 B

HIV

 C

Malignant condition

 D

Divorce case

Q. 18

Privileged communication may be made by a doctor in:           

September 2003

 A

Notifiable diseases

 B

HIV

 C

Malignant condition

 D

Divorce case

Ans. B

Explanation:

Ans. B i.e. HIV


Q. 19

Amongst the following, which carries the least chance of transmitting HIV infection:      

September 2010

 A

Heterosexual Intercourse

 B

Blood transfusion

 C

Vertical transmission

 D

IV drug abusers

Q. 19

Amongst the following, which carries the least chance of transmitting HIV infection:      

September 2010

 A

Heterosexual Intercourse

 B

Blood transfusion

 C

Vertical transmission

 D

IV drug abusers

Ans. A

Explanation:

Ans. A: Heterosexual Intercourse.

Heterosexual Intercourse is the most common route but the chance of infection is less (0.30%) ,looking to the other options.

Average per act risk of getting HIV
by exposure route to an infected source
Exposure route Chance of infection
Blood transfusion 90%
Childbirth (to child) 25%
Needle-sharing injection drug use 0.67%
Percutaneous needle stick 0.30%
Receptive anal intercourse* 0.04–3.0%
Insertive anal intercourse* 0.03%
Receptive penile-vaginal intercourse* 0.05–0.30%
Insertive penile-vaginal intercourse* 0.01–0.38%
Receptive oral intercourse 0–0.04%
Insertive oral intercourse 0–0.005%
* assuming no condom use
§ source refers to oral intercourse
performed on a man
  • Most commonly, people get or transmit HIV through sexual behaviors and needle or syringe use.
  • MC mode of transmission: Hetero-sexual
  • In hetero-sexual transmission: Male to female is commoner (as compared to female to male)
  • Chances of transmission with accidental needle prick: 0.3%.
  • Less commonly, HIV may be spread

  • In extremely rare cases, HIV has been transmitted by

    • Oral sex—putting the mouth on the penis (fellatio), vagina (cunnilingus), or anus (rimming). In general, there’s little to no risk of getting HIV from oral sex. 
    • Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This was more common in the early years of HIV, but now the risk is extremely small because of rigorous testing of the blood supply and donated organs and tissues.
    • Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs when infected blood from a caregiver’s mouth mixes with food while chewing. The only known cases are among infants.
    • Being bitten by a person with HIV. Each of the very small number of documented cases has involved severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken.
    • Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids.
    • Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from the HIV-positive partner gets into the bloodstream of the HIV-negative partner. HIV is not spread through saliva.

Q. 20

The chance that a health worker gets HIV from an accidental needle prick is:

March 2013 (b, h)

 A

0.3%

 B

20-30%

 C

3040%

 D

20%

Q. 20

The chance that a health worker gets HIV from an accidental needle prick is:

March 2013 (b, h)

 A

0.3%

 B

20-30%

 C

3040%

 D

20%

Ans. A

Explanation:

Ans. A i.e. 0.3%

Taken together, the data from several large studies suggest that the risk of HIV infection following a Percutaneous exposure to HIV contaminated blood is nearly 0.3% and after a mucous membrane exposure, approximately 0.09%

HIV

  • HIV is Single stranded, Positive sense, RNA virus
  • HIV is found in Blood, Semen, Saliva
  • HIV consists of 2 copies of ss RNA, RNA dependent DNA polymerase (reverse transcriptase) [compare with HBV], Integrase, Protease
  • Seroconversion takes 4 weeks
  • MC mode of transmission: Hetero-sexual
  • In hetero-sexual transmission: Male to female is commoner (as compared to female to male)
  • Chances of transmission with accidental needle prick: 0.3%
  • Retroviral sequence in host cell: RNA-DNA-RNA
  • p24 antigen (used for early diagnosis) disappears after: 6-8 weeks of HIV infection
  • CD4: CD8 ratio is Reversed in HIV infection
  • Reservoir of HIV infection: Macrophages
  • Window period: Time period between, infection to appearance of antibodies in serum
  • During window period, ELISA and western blot are: Negative
  • MC cause of diarrhea in AIDS: Cryptosporodiosis (NOT cryptococcus)
  • MC cause of meningitis in AIDS: Cryptococcus
  • MC cause of oral ulcer in AIDS: Candida
  • MC cause of TB in AIDS in tropical countries: Mycobacterium TB
  • MC opportunistic infection in AIDS in India is TB
  • Window period: Time period between infection and detection of antibodies against HIV
  • Hallmark of HIV:

—  Profound immunodeficiency,

— Quantitative and qualitative deficiency of helper or inducer T cells

  • AIDS related neoplasm:

– Kaposi sarcoma,

– B cell non-Hodgkins lymphoma

— Primary lymphoma of brain

  • Kaposi sarcoma arises from: Cells lining lymph vessels or blood vessels
  • Kaposi sarcoma is associated with:

— HIV,

— Immunosuppression/ organ transplants



Q. 21

Possibility of vertical transfer of HIV infection if prophylaxis is given:      

March 2007

 A

1%

 B

2%

 C

3%

 D

4%

Q. 21

Possibility of vertical transfer of HIV infection if prophylaxis is given:      

March 2007

 A

1%

 B

2%

 C

3%

 D

4%

Ans. A

Explanation:

Ans. A: 1%

Possibility of vertical transfer of HIV infection in pregnant woman who are receiving combination antiretroviral therapy is approaching 1%.


Q. 22

Possibility of vertical transfer of HIV infection if no prophylaxis is given:

March 2007

 A

25%

 B

50%

 C

75%

 D

100%

Q. 22

Possibility of vertical transfer of HIV infection if no prophylaxis is given:

March 2007

 A

25%

 B

50%

 C

75%

 D

100%

Ans. A

Explanation:

Ans. A: 25%

Probability of vertical transfer of HIV infection if no prophylactic antiretroviral therapy is given to the mother during pregnancy,labor and delivery and to the newborn ranges from 15-25% in the industrialized countries and from 25-35% in the developing countries.


Q. 23

Donor Breast milk is known to transmit all EXCEPT:

September 2012

 A

Tuberculosis

 B

CMV

 C

HIV

 D

Rubella

Q. 23

Donor Breast milk is known to transmit all EXCEPT:

September 2012

 A

Tuberculosis

 B

CMV

 C

HIV

 D

Rubella

Ans. D

Explanation:

Ans. D i.e. Rubella


Q. 24

The chance that a health worker gets HIV from an accidental needle prick is –

 A

1%

 B

10%

 C

95%

 D

100%

Q. 24

The chance that a health worker gets HIV from an accidental needle prick is –

 A

1%

 B

10%

 C

95%

 D

100%

Ans. A

Explanation:

Ans. is `a’ i.e., 1%



Human Immunodeficiency Virus (HIV)

Human Immunodeficiency Virus (HIV)

Q. 1

RNA oncogenic virus amongst the following is? 

 A

HIV

 B

HTLV

 C

HBV

 D

A and B

Q. 1

RNA oncogenic virus amongst the following is? 

 A

HIV

 B

HTLV

 C

HBV

 D

A and B

Ans. D

Explanation:

Ans. is ‘a’ i.e., HIV & ‘b’ i.e., HTLV 

  • Retroviruses contain an RNA genome and an RNA-directed DNA polymerase (reverse transcriptase). Both HIV and HTLV are Oncogenic reterovirus

Association of viruses with human cancers (Jawetz)

Virus family

Virus

Human cancer

Papillomaviridae

Human papillomaviruses

Genital tumors

 

 

Squamous cell carcinoma

 

 

Oropharyngeal carcinoma

Herpesviridae

EB virus

Nasopharyngeal carcinoma

 

 

Burkitt’s lymphoma

 

 

Hodgkin’s disease

 

 

B cell lymphoma

 

Human herpesvirus 8

Kaposi’s sarcoma

Hepadnaviridae

Hepatitis B virus

Hepatocellular carcinoma

Retroviridae

HTL virus

Adult T cell leukemia

 

Human immunodeficiency virus

AIDS related malignancies

Flaviviridae

Hepatitis C virus

Hepatocellular carcinoma


Q. 2

The gene coding for core of HIV is –

 A

GAG

 B

ENV

 C

POL

 D

TAT

Q. 2

The gene coding for core of HIV is –

 A

GAG

 B

ENV

 C

POL

 D

TAT

Ans. A

Explanation:

Ans. is ‘a’ i.e., GAG


Q. 3

The HIV virus can be destroyed in vitro by which of the following –

 A

Boiling

 B

Ethanol

 C

Cidex

 D

All of the above

Q. 3

The HIV virus can be destroyed in vitro by which of the following –

 A

Boiling

 B

Ethanol

 C

Cidex

 D

All of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., All of the above


Q. 4

Which of the following cell types is not a target for initiation and maintenance of HIV infection?

 A

CD4 T cell

 B

Macrophage

 C

Dendritic cell

 D

Neutrophil

Q. 4

Which of the following cell types is not a target for initiation and maintenance of HIV infection?

 A

CD4 T cell

 B

Macrophage

 C

Dendritic cell

 D

Neutrophil

Ans. D

Explanation:

Ans. is ‘d’ i.e., Neutrophil


Q. 5

HIV prevalence can be assessed by- 

 A

Sentinel surveillance 

 B

Active

 C

Passive

 D

Register

Q. 5

HIV prevalence can be assessed by- 

 A

Sentinel surveillance 

 B

Active

 C

Passive

 D

Register

Ans. A

Explanation:

Ans. is ‘a’ i.e., Sentinel surveillance 

o Sentinel surveillance in India is done in national AIDS control programme.


Q. 6

HIV affects:

March 2005 and 2008, and September 2011

 A

CD4 cells

 B

CD8 cells

 C

Natural killer cells

 D

Helper cells

Q. 6

HIV affects:

March 2005 and 2008, and September 2011

 A

CD4 cells

 B

CD8 cells

 C

Natural killer cells

 D

Helper cells

Ans. A

Explanation:

Ans. A: CD4 cells

CD4 (cluster of differentiation 4) is a glycoprotein expressed on the surface of T helper cells, regulatory T cells, monocytes, macrophages, and dendritic cells.

CD4 is a primary receptor used by HIV-1 to gain entry into host T cells.

HIV-1 attaches to CD4 with a protein in its viral envelope known as gp120.

The binding to CD4 creates a shift in the conformation of gp120 allowing HIV-1 to bind to two other surface receptors on the host cell, the chemokine receptors CCR5 or CXCR4, depending on whether HIV is infecting a macrophage or T-helper cell.

Following a structural change in another viral protein (gp41), HIV inserts a fusion peptide into the host cell that allows the outer membrane of the virus to fuse with the cell membrane.

HIV infection leads to a progressive reduction in the number of T cells possessing CD4 receptors. Therefore, medical professionals refer to the CD4 count to decide when to begin treatment for HIV-infected patients.



Q. 7

HIV contains:     

March 2013

 A

Integrase

 B

RNA directed DNA polymerase

 C

Ribonuclease

 D

All of the above

Q. 7

HIV contains:     

March 2013

 A

Integrase

 B

RNA directed DNA polymerase

 C

Ribonuclease

 D

All of the above

Ans. D

Explanation:

Ans. D i.e. All of the above

HIV virus

  • It is composed of two copies of positive single-stranded RNA that codes for the virus’s nine genes enclosed by a conical capsid composed of 2,000 copies of the viral protein p24.
  • The single-stranded RNA is tightly bound to nucleocapsid proteins, p7, and enzymes needed for the development of the virion such as reverse transcriptase, proteases, ribonuclease and integrase.
  • A matrix composed of the viral protein p17 surrounds the capsid ensuring the integrity of the virion particle.

Q. 8

All of the following is true regarding HIV virus except:

March 2010

 A

Belongs to the subgroup lentivirus

 B

Double stranded DNA virus

 C

Characterised by the presence of reverse transcriptase enzyme

 D

Acts on CD4 cells

Q. 8

All of the following is true regarding HIV virus except:

March 2010

 A

Belongs to the subgroup lentivirus

 B

Double stranded DNA virus

 C

Characterised by the presence of reverse transcriptase enzyme

 D

Acts on CD4 cells

Ans. B

Explanation:

Ans. B: Double stranded DNA virus

HIV belongs to the lentivirus subgroup of the family retroviridae.

HIV is a spherical, enveloped virus. The genome is diploid, composed of two identical single-stranded, positive sense RNA copies.

The human immunodeficiency virus (HIV) like many other viruses, stores its genetic information as RNA rather than as DNA (most other living things use DNA).

In association with viral RNA is the reverse transcriptase enzyme which is a characteristic feature of retroviruses.

When HIV enters a human cell, it releases its RNA, and an enzyme called reverse transcriptase makes a DNA copy of the HIV RNA. The resulting HIV DNA is integrated into the infected cell’s DNA. This process is the reverse of that used by human cells, which make an RNA copy of DNA. Thus, HIV is called a retrovirus, referring to the reversed (backward) process. Other RNA viruses (such as polio, influenza, or measles), unlike retroviruses, do not make DNA copies after they invade cells. They simply make RNA copies of their original RNA.

Some types of white blood cells called CD4+ lymphocytes

HIV is highly mutable virus, unlike HTLV.


Q. 9

P24 Antigen in HIV infection as shown in the photograph below is represented by ? 

 A

A

 B

B

 C

C

 D

None.

Q. 9

P24 Antigen in HIV infection as shown in the photograph below is represented by ? 

 A

A

 B

B

 C

C

 D

None.

Ans. C

Explanation:

Ans:A.




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