HIV co-infections (HBV, HCV, TB) — MCQs

A scientist is researching the long term effects of the hepatitis viruses on hepatic tissue. She finds that certain strains are oncogenic and increase the risk of hepatocellular carcinoma. However, they appear to do so via different mechanisms. Which of the following answer choices correctly pairs the hepatitis virus with the correct oncogenic process?

A 52-year-old male patient with chronic alcoholism presents to an ambulatory medical clinic, where the hepatologist elects to perform comprehensive hepatitis B screening, in addition to several other screening and preventative measures. Given the following choices, which serologic marker, if positive, would indicate the patient’s immunity to the hepatitis B virus?

A 30-year-old woman presents with generalized fatigue, joint pain, and decreased appetite. She says that symptoms onset a year ago and have not improved. The patient’s husband says he has recently noticed that her eyes and skin are yellowish. The patient denies any history of smoking or alcohol use, but she admits to using different kinds of intravenous illicit drugs during her college years. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable, except for moderate scleral icterus. A polymerase chain reaction (PCR) of a blood sample is positive for a viral infection that reveals a positive-sense RNA virus, that is small, enveloped, and single-stranded. The patient is started on a drug that resembles a purine RNA nucleotide. She agrees not to get pregnant before or during the use of this medication. Which of the following is the drug that was most likely given to this patient?

A 24-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 1 diabetes mellitus. His only medication is insulin. He immigrated from Nepal 2 weeks ago . He lives in a shelter. He has smoked one pack of cigarettes daily for the past 5 years. He has not received any routine childhood vaccinations. The patient appears healthy and well nourished. He is 172 cm (5 ft 8 in) tall and weighs 68 kg (150 lb); BMI is 23 kg/m2. His temperature is 36.8°C (98.2°F), pulse is 72/min, and blood pressure is 123/82 mm Hg. Examination shows a healed scar over his right femur. The remainder of the examination shows no abnormalities. A purified protein derivative (PPD) skin test is performed. Three days later, an induration of 13 mm is noted. Which of the following is the most appropriate initial step in the management of this patient?

A 35-year-old man with no known past medical history presents to his physician because he is applying for a job as a healthcare worker, which requires screening for the hepatitis B virus (HBV). The patient states that he is in good health and denies any symptoms. His vital signs and physical exam are unremarkable. Labs are drawn, and the patient's HBV serology shows the following: HBsAg: positive anti-HBsAg antibody: negative anti-HBcAg IgM: negative anti-HBcAg IgG: positive HBeAg: negative anti-HBeAg antibody: positive Which of the following best describes this patient's results?

A 52-year-old woman comes to the physician because of abdominal discomfort, anorexia, and mild fatigue. She has systemic lupus erythematosus and takes hydroxychloroquine. She does not drink alcohol or use illicit drugs. Physical examination shows no abnormalities. Laboratory studies show: Alanine aminotransferase 455 U/L Aspartate aminotransferase 205 U/L Hepatitis B surface antigen positive Hepatitis B surface antibody negative Hepatitis B envelope antigen positive Hepatitis B core antigen IgG antibody positive Which of the following is the most appropriate pharmacotherapy for this patient?

A 27-year-old man presents with a 2-week history of fever, malaise, and occasional diarrhea. On physical examination, the physician notes enlarged inguinal lymph nodes. An HIV screening test is positive. Laboratory studies show a CD4+ count of 650/mm3. This patient is most likely currently in which of the following stages of HIV infection?

A 52-year-old man presents to his physician after his routine screening revealed that he has elevated liver enzymes. He complains of occasional headaches during the past year, but otherwise feels well. The patient reports that he was involved in a serious car accident in the 1980s. He does not smoke or drink alcohol. He has no history of illicit intravenous drug use. He does not currently take any medications and has no known allergies. His father had a history of alcoholism and died of liver cancer. The patient appears thin. His temperature is 37.8°C (100°F), pulse is 100/min, and blood pressure is 110/70 mm Hg. The physical examination reveals no abnormalities. The laboratory test results show the following: Complete blood count Hemoglobin 14 g/dL Leukocyte count 10,000/mm3 Platelet count 146,000/mm3 Comprehensive metabolic profile Glucose 150 mg/dL Albumin 3.2 g/dL Total bilirubin 1.5 mg/dL Alkaline phosphatase 75 IU/L AST 95 IU/L ALT 73 IU/L Other lab tests HIV negative Hepatitis B surface antigen negative Hepatitis C antibody positive HCV RNA positive HCV genotype 1 A liver biopsy is performed and shows mononuclear infiltrates localized to portal tracts that reveal periportal hepatocyte necrosis. Which of the following is the most appropriate next step in management?

A 45-year-old man presents for follow-up to monitor his chronic hepatitis C treatment. The patient was infected with hepatitis C genotype 1, one year ago. He has been managed on a combination of pegylated interferon-alpha and ribavirin, but a sustained viral response has not been achieved. Past medical history is significant for non-alcoholic fatty liver disease for the last 5 years. Which of the following, if added to the patient’s current treatment regimen, would most likely benefit this patient?

A 57-year-old man comes to the physician because of generalized malaise, yellowish discoloration of the eyes, and pruritus on the back of his hands that worsens when exposed to sunlight for the past several months. He has not seen a physician in 15 years. Physical examination shows scleral icterus and mild jaundice. There is a purpuric rash with several small vesicles and hyperpigmented lesions on the dorsum of both hands. The causal pathogen of this patient's underlying condition was most likely acquired in which of the following ways?