HIV and AIDS — MCQs
A person with AIDS related complex is most likely suffering from:
A child presents with a fever and a rash. Urine examination showed cells with owl's eye appearance. What is the most likely diagnosis?
In diagnosis of AIDS, criteria include the following except -
A malnourished child from a poor socioeconomic status, residing in overcrowded and dirty areas, presents with a nodule around the limbus and hyperemia of the surrounding conjunctiva in his left eye, as well as axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis?
Infection with HIV is associated with atrophy in all of the following parts of the brain except:
Which of the following is NOT a feature of CMV retinitis?
Identify the logo?
All are manifestation of dengue virus infection in eye except?
What is the most common orbital tumor in children?
In a patient with acute anterior uveitis presenting with raised intraocular pressure, the PRIMARY treatment should be:
HIV and AIDS Indian Medical PG Practice Questions and MCQs
Question 1: A person with AIDS related complex is most likely suffering from:
- A. Opportunistic infection (Correct Answer)
- B. Generalized lymphadenopathy
- C. Cancer related to AIDS
- D. Herpes zoster
Explanation: ***Opportunistic infection*** - AIDS-related complex (ARC) describes symptoms experienced by individuals with **HIV infection** before the full onset of AIDS, often including systemic symptoms and increased susceptibility to infections. - The immunocompromised state in ARC makes patients highly vulnerable to **opportunistic infections**, which are common presentations during this phase [1]. *Generalized lymphadenopathy* - While **generalized lymphadenopathy** is a common feature of HIV infection and can be part of ARC, it is a symptom or sign, not the primary "suffering" that defines much of the morbidity [1]. - **Persistent generalized lymphadenopathy (PGL)** is characterized by enlarged lymph nodes in two or more extrainguinal sites for over three months, often seen in early HIV infection, but it *doesn't fully encompass* "suffering" as broadly as opportunistic infections do [1]. *Cancer related to AIDS* - **AIDS-defining cancers** (e.g., Kaposi's sarcoma, non-Hodgkin lymphoma) are more characteristic of full-blown AIDS, when the immune system is severely compromised (CD4 count typically < 200 cells/µL). - While the risk of certain cancers increases with HIV, and some may occur in ARC, **opportunistic infections** are a more ubiquitous and defining feature of the "suffering" associated with the ARC stage [1]. *Herpes zoster* - **Herpes zoster**, or shingles, results from reactivation of the varicella-zoster virus and is more prevalent and often more severe in HIV-positive individuals, including those with ARC [1]. - However, it represents *one specific type* of opportunistic infection or condition, and the question asks what the person is "most likely suffering from" in a general sense within ARC, for which opportunistic infections are the overarching category.
Question 2: A child presents with a fever and a rash. Urine examination showed cells with owl's eye appearance. What is the most likely diagnosis?
- A. Herpes simplex virus infection
- B. Toxoplasmosis caused by Toxoplasma gondii
- C. Cytomegalovirus (CMV) infection (Correct Answer)
- D. Infectious mononucleosis caused by Epstein-Barr virus
Explanation: ***Cytomegalovirus (CMV) infection*** - The presence of cells with an **owl's eye appearance** in urine sediment is a classic histological hallmark of **CMV infection**. - CMV can cause a variety of symptoms in children, including **fever and rash**, making this the most likely diagnosis. *Herpes simplex virus infection* - HSV causes characteristic **vesicular lesions** on mucocutaneous surfaces, often associated with fever. - While HSV can cause systemic illness, it does not typically present with **owl's eye inclusions** in urine cells. *Toxoplasmosis caused by Toxoplasma gondii* - **Toxoplasmosis** can cause fever and rash, especially in congenital infections or immunocompromised individuals. - However, it does not lead to **owl's eye inclusions** in urinary cells, which are pathognomonic for CMV. *Infectious mononucleosis caused by Epstein-Barr virus* - **Infectious mononucleosis** commonly presents with fever, fatigue, and lymphadenopathy, sometimes with a rash. - **Epstein-Barr virus (EBV)** infection does not produce cells with an **owl's eye appearance** in the urine; that is specific to CMV.
Question 3: In diagnosis of AIDS, criteria include the following except -
- A. CD8<500 (Correct Answer)
- B. CD4<200
- C. Presence of any of the opportunistic infections tuberculosis, pneumocystis carinii, cytomegalovirus
- D. CD4 : CD 8 =1
Explanation: ***CD8<500*** - While **CD8+ T cells** are involved in the immune response to HIV, their absolute count is not a primary criterion for diagnosing or staging **AIDS**. - **AIDS** diagnosis is primarily based on **CD4+ T cell counts** and the presence of **AIDS-defining opportunistic infections** [1]. *CD4<200* - A **CD4+ T cell count** below **200 cells/µL** is a key diagnostic criterion for **AIDS**, indicating severe immunosuppression [1]. - This threshold signifies a significantly compromised immune system, making the individual highly susceptible to opportunistic infections. *Presence of any of the opportunistic infections tuberculosis, pneumocystis carinii, cytomegalovirus* - The occurrence of **AIDS-defining opportunistic infections** like **tuberculosis**, **Pneumocystis jirovecii pneumonia**, or **cytomegalovirus retinitis** in an HIV-positive individual confirms an **AIDS diagnosis**, regardless of the CD4 count [1]. - These infections typically manifest when the immune system is severely weakened. *CD4 : CD 8 =1* - A **CD4:CD8 ratio of 1** (or any specific ratio) is not a direct criterion for diagnosing **AIDS**. - In HIV infection, the **CD4:CD8 ratio typically inverts** (becomes less than 1) as CD4 cells decline, but this ratio alone is not a defining characteristic for AIDS.
Question 4: A malnourished child from a poor socioeconomic status, residing in overcrowded and dirty areas, presents with a nodule around the limbus and hyperemia of the surrounding conjunctiva in his left eye, as well as axillary and cervical lymphadenopathy. Which of the following is the most likely diagnosis?
- A. Phlyctenular conjunctivitis (Correct Answer)
- B. Foreign body granuloma
- C. Vernal keratoconjunctivitis
- D. Episcleritis
Explanation: ***Phlyctenular conjunctivitis*** - This condition is an immune-mediated hypersensitivity reaction to a foreign antigen, often associated with systemic diseases like **tuberculosis** or **Staphylococcus aureus** infection, commonly seen in malnourished children from poor socioeconomic backgrounds. - The characteristic lesion is a **nodule (phlyctenule)** near the **limbus** with surrounding conjunctival hyperemia, which aligns with the child's presentation. *Foreign body granuloma* - A **foreign body granuloma** is a reaction to a foreign material embedded in the conjunctiva or sclera, typically caused by trauma or an identifiable foreign object. - It does not explain the concurrent **axillary and cervical lymphadenopathy** or the association with malnutrition and poor hygiene. *Vernal keratoconjunctivitis* - **Vernal keratoconjunctivitis** is a chronic, bilateral allergic disorder, primarily affecting children and young adults, often seasonal and related to atopy. - It is characterized by **giant papillae on the tarsal conjunctiva** and often forms a **Trantas dot** on the limbus, which are different from a single limbal nodule and not typically associated with lymphadenopathy or socioeconomic factors in this way. *Episcleritis* - **Episcleritis** is an acute, self-limiting inflammation of the episcleral tissue, presenting as **sectoral or diffuse redness** and mild discomfort. - It does not involve a distinct nodule around the limbus or systemic symptoms like **lymphadenopathy**, nor is it directly linked to malnutrition or poor hygiene.
Question 5: Infection with HIV is associated with atrophy in all of the following parts of the brain except:
- A. Caudate nucleus
- B. Anterior cingulate gyrus
- C. Globus pallidus
- D. Lower white matter volume (Correct Answer)
Explanation: Infection with HIV is associated with atrophy in all of the following parts of the brain except: ***Lower white matter volume*** - HIV infection and associated neurocognitive disorders (HAND) are characterized by **atrophy of gray matter structures** and **decreased cortical thickness**. - While HIV can affect white matter, it typically leads to **white matter injury** and **demyelination**, which is reflected as **increased white matter volume** due to reactive gliosis rather than atrophy [1]. *Caudate nucleus* - The **caudate nucleus**, a component of the **basal ganglia**, is frequently affected by HIV, often showing significant atrophy [2]. - This atrophy is associated with neurocognitive impairments seen in **HIV-associated neurocognitive disorder (HAND)** [1]. *Anterior cingulate gyrus* - The **anterior cingulate gyrus**, a crucial part of the **limbic system** involved in cognitive functions and emotion, often exhibits **atrophy in HIV patients**. - This atrophy contributes to cognitive deficits and mood disturbances common in **HIV-infected individuals**. *Globus pallidus* - The **globus pallidus**, another key structure of the **basal ganglia**, is known to undergo **atrophy in HIV infection** [2]. - Atrophy in this region is linked to **motor dysfunction and cognitive impairments** observed in **advanced HIV disease**.
Question 6: Which of the following is NOT a feature of CMV retinitis?
- A. Perivasculitis
- B. Brush-fire appearance
- C. Immunosuppression
- D. Cracked mud appearance (Correct Answer)
Explanation: ***Cracked mud appearance*** - **"Cracked mud appearance"** is not a term used to describe CMV retinitis. The classic descriptions include **"pizza pie"**, **"cottage cheese and ketchup"**, and **"brush-fire"** appearances. - CMV retinitis presents with **necrotizing retinitis** with hemorrhages and granular opacification, not a cracked or atrophic pattern. - This option describes a **non-existent finding** in the context of CMV retinitis. *Immunosuppression* - **Immunosuppression**, especially due to **HIV/AIDS** (CD4 count <50 cells/μL), organ transplantation, or chemotherapy, is a **primary risk factor** for CMV retinitis. - It is crucial for the **reactivation** of latent CMV infection, leading to opportunistic disease. - While technically a predisposing condition rather than a "feature" of the disease itself, it is strongly associated with CMV retinitis. *Brush-fire appearance* - The **"brush-fire appearance"** is a classic description of CMV retinitis, referring to the **active leading edge** of the infection with confluent areas of necrosis and hemorrhage spreading across the retina. - This term captures the **fulminant necrotizing retinitis** with yellow-white retinal opacification and hemorrhages. *Perivasculitis* - **Perivasculitis**, or inflammation around the retinal blood vessels, is a **characteristic pathological feature** of CMV retinitis. - It often manifests as **frosted branch angiitis** (white sheathing around retinal vessels), which can be seen in severe cases.
Question 7: Identify the logo?
- A. Leprosy (Correct Answer)
- B. TB
- C. Malaria
- D. HIV
Explanation: ***Leprosy*** - This logo, often featuring a stylized flower or protective shape, is widely recognized as a symbol associated with **leprosy awareness** and efforts to eradicate the disease. - Organizations dedicated to **leprosy elimination** and care frequently use similar designs to represent compassion, hope, and the journey towards healing for individuals affected by this condition. *TB* - The emblem for **tuberculosis (TB)** awareness predominantly features a **red ribbon**, which symbolizes solidarity in the fight against the disease. - While TB is a global health concern, its associated imagery differs significantly from the flower-like logo presented. *Malaria* - The international symbol for **malaria** often incorporates a stylized **mosquito** or images representing its lifecycle and geographic prevalence. - The logo displayed does not resemble any common imagery used in malaria prevention or awareness campaigns. *HIV* - The **red ribbon** is the most universally recognized symbol for **HIV/AIDS** awareness, representing solidarity with people living with HIV and those who have died from AIDS. - This specific logo does not align with the established iconography for HIV/AIDS.
Question 8: All are manifestation of dengue virus infection in eye except?
- A. Cataract (Correct Answer)
- B. Vitreous hemorrhage
- C. Maculopathy
- D. Optic neuritis
Explanation: ***Cataract*** - **Cataracts** are primarily associated with aging, congenital factors, trauma, or long-term steroid use, not directly with acute dengue virus infection. - While dengue can cause various ocular manifestations, the formation of cataracts is a **chronic process** that does not fit the typical acute or subacute presentation of dengue-related eye complications. *Vitreous hemorrhage* - **Vitreous hemorrhage** can occur in dengue due to associated **thrombocytopenia** and coagulation abnormalities, leading to bleeding in the eye. - Severe dengue can induce systemic vasculopathy and bleeding tendencies, which may manifest as intraocular hemorrhage. *Maculopathy* - **Dengue maculopathy** is a recognized complication, often presenting as macular edema, hemorrhage, or foveolitis, leading to visual impairment. - This is thought to be due to direct viral effects, immune-mediated responses, or vasculitis affecting the retinal microvasculature. *Optic neuritis* - **Optic neuritis** following dengue infection has been reported, characterized by inflammation of the optic nerve, causing acute vision loss. - This is considered to be an **immune-mediated post-infectious complication** rather than a direct viral cytopathic effect on the nerve.
Question 9: What is the most common orbital tumor in children?
- A. Nerve sheath tumor
- B. Hemangioma (Correct Answer)
- C. Lymphoma
- D. Meningioma
Explanation: ***Hemangioma*** - **Capillary hemangioma** is the **most common benign orbital tumor/mass** in children, typically presenting in the first few months of life. - It is characterized by **rapid growth during the first year**, followed by **spontaneous involution** (usually complete by age 5-7 years). - These lesions are composed of rapidly proliferating endothelial cells and can cause **proptosis, ptosis**, and, if large, **amblyopia** due to visual axis obstruction or induced astigmatism. - Management is often conservative (observation) unless vision-threatening, in which case systemic steroids or propranolol may be used. *Nerve sheath tumor* - **Optic nerve sheath meningiomas** and **schwannomas** are rare in children, typically presenting in older adults. - While they can cause visual impairment and proptosis, their incidence in the pediatric population is significantly lower than hemangiomas. *Lymphoma* - **Orbital lymphoma** is exceedingly rare in children and is typically a tumor of adulthood, often associated with systemic lymphoma. - When it does occur in children, it might be a manifestation of a more widespread lymphoproliferative disorder. *Meningioma* - **Meningiomas** generally arise from arachnoid cap cells and are less common in children than in adults. - In children, they are more often associated with **neurofibromatosis type 2** and tend to be more aggressive.
Question 10: In a patient with acute anterior uveitis presenting with raised intraocular pressure, the PRIMARY treatment should be:
- A. Topical steroids (Correct Answer)
- B. Topical beta-blockers
- C. Cycloplegics
- D. Miotics
Explanation: ***Topical steroids*** - **Topical corticosteroids** are the primary treatment for **anterior uveitis** to reduce inflammation, which is the underlying cause of both the uveitis and often the raised IOP. - While IOP is elevated, managing the inflammation with steroids is crucial, as the inflammation itself can lead to secondary **IOP elevation** due to trabecular meshwork dysfunction or synechiae formation. *Topical beta-blockers* - **Topical beta-blockers** are used to lower intraocular pressure, but they do not address the underlying **inflammation** in acute anterior uveitis. - Using them alone without treating the inflammation can lead to progression of the uveitis and further ocular damage. *Cycloplegics* - **Cycloplegics** (e.g., atropine, cyclopentolate) are important adjuncts in acute anterior uveitis to relieve pain from ciliary spasm and prevent posterior synechiae formation by dilating the pupil. - They do not, however, treat the **inflammation** directly or primarily address the elevated intraocular pressure. *Miotics* - **Miotics** (e.g., pilocarpine) **constrict the pupil**, which can worsen symptoms in acute anterior uveitis by increasing ciliary body spasm and potentially increasing the risk of posterior synechiae formation. - They are contraindicated in acute anterior uveitis as they exacerbate pain and inflammation, and do not treat the underlying cause.
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