front 1 PM has been on antiretroviral therapy for eight years. During the last clinic visit, he had signs of drug resistance on his laboratory workup. The CD4 count was 350 cells/mm3. Which of the following medications should be prescribed to prevent an opportunistic infection (OI)? | back 1 The patient is not a candidate for prophylactic medications |
front 2 A 37-year-old female with HIV presented to her outpatient clinic. She was noted to have white plaques on her tongue and cheek. What treatment should be initiated? | back 2 Fluconazole |
front 3 GG is a 32-year-old female who comes to the office to discuss treatment options for HIV. She was recently diagnosed during an evaluation for fatigue and weight loss. She reports no rash, fever, cough, or night sweats, and her recent physical exam was unremarkable. Past Medical History: IV drug use (stopped 3 years ago), chlamydia infection (8 months ago), migraine headaches Social History: several sexual partners in her lifetime, currently in a monogamous relationship, no current use of recreational drugs or tobacco Allergies: sulfa (hives) CD4 count 180 cells/mm3 Additional Information: genotype results and all other baseline testing (hepatitis, tuberculosis, sexually transmitted infections) reviewed; initiate antiretroviral therapy with Truvada and Tivicay; counsel on adherence; follow-up in 2 weeks In addition to antiretroviral therapy, which prophylactic medication is most appropriate for this patient? | back 3 Dapsone |
front 4 LM is a 36-year-old female who was diagnosed with HIV in July. She was immediately started on ART with Tivicay and Descovy. She struggled with adherence and in September she stopped taking her ART medications altogether. In February, LM finally agreed to restart ART. Her recent CD4 count and viral loads are listed below.
7/14 (diagnosis)
Which of the following should have been initiated on 7/14? | back 4 Bactrim The CD4 count < 200 cells/mm3 indicates an increased risk for PCP. Primary prophylaxis with Bactrim should have been started. |
front 5 LM is a 36-year-old female who was diagnosed with HIV in July. She was immediately started on ART with Tivicay and Descovy. She struggled with adherence and in September she stopped taking her ART medications altogether. In February, LM finally agreed to restart ART. Her recent CD4 count and viral loads are listed below.
11/15
Which of the following should have been initiated on 11/15? | back 5 Azithromycin Azithromycin is the preferred drug for the primary prophylaxis against Mycobacterium avium complex. It should be started in patients with a CD4 count < 50 cells/mm3 who are not taking ART. |
front 6 TT, an HIV-positive male patient, comes to the emergency department accompanied by a friend. He has been noted to have altered mental status and has complained of severe headaches for the last 4 days. A lumbar puncture with cerebral spinal fluid Gram stain reveals many WBC and yeast. TT's CD4 count is 88 cells/mm3. TT is started on amphotericin B deoxycholate plus flucytosine. What condition has TT most likely developed? | back 6 Cryptococcal meningitis |
front 7 QT is a 41-year-old male who was diagnosed with HIV in January after he presented to his primary care provider with severe oral candidiasis. At the time of his diagnosis he was started on Prezista, ritonavir, Descovy, Bactrim DS daily, azithromycin 1,200 mg weekly and fluconazole 200 mg daily for 10 days. He takes Crestor, hydrochlorothiazide and Protonix for his other medical problems. His most recent CD4 count and viral load results are listed below.
9/17 (today)
Which of the following is appropriate at this time? | back 7 Azithromycin should be discontinued |
front 8 TS is a 62-year-old male with multiple medical problems, including HIV. He was diagnosed with HIV one year ago and started on antiretroviral therapy. He has never had an opportunistic infection. He is currently taking the following medications: Truvada, Tivicay, Bactrim DS, Zestril, Lasix, Coreg, Lantus and Protonix. His most recent CD4 and HIV viral load results are listed below. 9/15 (today) Viral load: <50 copies/mL CD4: 230 cell/mm3 What change in the medication regimen should be recommended today? | back 8 Discontinue Bactrim DS |
front 9 RB is a 38-year-old male who is HIV-positive with a CD4 count of 37 cells/mm3. He is not currently taking antiretroviral therapy but is taking Bactrim prophylaxis. Which medication should also be prescribed at this time? | back 9 Azithromycin 1,200 mg PO weekly |
front 10 A 45-year-old male with HIV has a CD4 count of 93 cells/mm3 and a positive toxoplasma IgG. Which of the following opportunistic infections should he receive prophylaxis against at this time? (Select ALL that apply.) | back 10 Toxoplasma gondii Pneumocystis pneumonia |
front 11 A patient is started on dapsone + pyrimethamine + leucovorin for primary prophylaxis of Pneumocystis pneumonia. What is the purpose of leucovorin in this regimen? | back 11 To reduce the risk of myelosuppression with pyrimethamine Leucovorin is used to prevent myelosuppression due to pyrimethamine. |
front 12 PS is an immunosuppressed transplant patient who requires a medication to prevent Pneumocystis pneumonia. She reports an itchy rash when taking Bactrim in the past. Which of the following drugs should be recommended? | back 12 Dapsone Dapsone or atovaquone are possible options for PCP prophylaxis in the setting of sulfa allergy. |
front 13 VT is a 41-year-old male with HIV. He has recently recovered from an episode of esophageal candidiasis. Which of the following should be prescribed for him in order to prevent further episodes of candidiasis? | back 13 No medication is needed |
front 14 Which of the following would create an immunocompromised state? (Select ALL that apply.) | back 14 Oral methotrexate for rheumatoid arthritis Monthly infliximab infusions for ulcerative colitis Paciltaxel infusions in a patient with an ANC of 450 cells/mm3 |
front 15 MK is a 31-year-old male who presents to the HIV clinic today for a
routine appointment. He is doing well and has no complaints at this time. CD4 (800 – 1,100 cells/mm3)=142 Which medication should be prescribed for MK? | back 15 Bactrim DS 1 tab PO daily |
front 16 CV is a 39-year-old male with HIV and CMV retinitis. His response to valganciclovir was poor and additional viral testing shows the development of resistance to valganciclovir. Which of the following alternatives would be expected to have activity in this case? (Select ALL that apply.) | back 16 Cidofovir, foscarnet Valganciclovir is an oral prodrug of ganciclovir, so a virus that is resistant to one cannot be treated with the other. Cidofovir and foscarnet are intravenous treatment options. Acyclovir is used for herpes simplex and herpes zoster infections and atovaquone is an alternative prophylaxis agent for PCP. |
front 17 What is the preferred regimen for the treatment of Toxoplasmosis gondii encephalitis? | back 17 Pyrimethamine + leucovorin + sulfadiazine |
front 18 Which of the following best represents guideline criteria for discontinuation of Mycobacterium avium complex primary prophylaxis? | back 18 Taking fully suppressive antiretroviral therapy |
front 19 All of the following disease-treatment pairs is correct EXCEPT: | back 19 cryptococcal meningitis- liposomal amphotericin B + foscarnet |
front 20 An HIV-positive patient with a history of poor medication adherence has a CD4 count less than 50 cells/mm3. He develops cytomegalovirus (CMV) retinitis. Which of the following medications has activity against CMV? | back 20 Valganciclovir |
front 21 History of Present Illness: SM is a 36-year-old male who presents to the HIV clinic for a routine appointment. He is doing well and has no major complaints at this time. He states that he uses his albuterol inhaler 4 days per week (about 6 puffs on each of those days) and has been trying over-the-counter medications to manage occasional heartburn. Allergies: sulfa (hives) Past Medical History: HIV (no history of opportunistic infections)AsthmaDyslipidemia Medications: Truvada 1 tablet PO dailyTivicay 50 mg PO dailyAlbuterol MDI 1-2 inhalations 3-4 times daily, as neededAfrin 2-3 sprays in each nostril twice daily, as needed Simvastatin 20 mg PO QHS CD4+ (cells/mm3) = 126 (800 – 1,100) Which of the following should be added to SM's medication regimen? | back 21 Dapsone+ pyrimethamine+ leucovorin |
front 22 What is a preferred regimen for primary prophylaxis of Pneumocystis pneumonia? | back 22 Sulfamethoxazole/Trimethoprim DS 1 tab PO daily |