SMALL GROUP

DISCUSSION
26/03/2022

Q 1) During heterosexual intercourse, seminal fluid containing

HIV contacts vaginal squamous mucosa. Cells capture virions
and transport the virus via lymphatics to regional lymph nodes.
Within the germinal centers of these lymph nodes, the virions
infect CD4+ lymphocytes and proliferate, causing CD4+ cell
lysis with release of more virions, which are taken up on the
surface of cells having Fc receptors, allowing continued
infection by HIV of more CD4+ cells passing through the
nodes. Which of the following types of cells is most likely to
capture HIV on its surface via Fc receptors?
 A B lymphocyte
B CD8+ cytotoxic lymphocyte
C Follicular dendritic cell
D Natural Killer cell
E Langhans giant cell
F Macrophage
G Mast cell

Q 2) A 28-year-old woman with a 9-year history of injection drug use has developed a
chronic watery diarrhea that has persisted for the past week. On physical examination,
she is afebrile and has mild muscle wasting. Her body mass index is 18. Laboratory
studies of her stool show cysts of Cryptosporidium parvum. One month later, she
develops cryptococcal meningitis, which is treated successfully. Oral candidiasis is
diagnosed 1 month later. This patient is at greatest risk of developing which of the
following neoplasms?

A Cerebral astrocytoma
B Cervical clear cell carcinoma
C Cerebral non-Hodgkin lymphoma
D Pulmonary adenocarcinoma
E Retroperitoneal sarcoma
Q 3) A 41-year-old man has been infected with HIV for the past 8 years.
He then began receiving antiretroviral therapy, continued for the past 18
months with a regimen that includes multiple drugs. His HIV-1 RNA level
initially decreased to less than 50 copies/µL after initiation of therapy; the
current level is 5120 copies/µL. A mutation in the gene for which of the
following molecules is most likely to have occurred?

A CD40 ligand
B Chemokine receptor
C Cytokine receptor γ chain
D p24 antigen
E Protein tyrosine kinase
F Reverse transcriptase

Q 4) At 19 years of age, a previously healthy woman had an acute illness with fever,
myalgia, sore throat, and mild erythematous rash over the abdomen and thighs. These
symptoms abated after 1 month. She then remained healthy for 10 years. Now she has
decreased visual acuity and pain in the right eye. Fundoscopic examination shows
findings of cytomegalovirus retinitis. Examination of her oral cavity shows thrush
(candidiasis). Which of the following laboratory findings would most likely be present
after her ocular problems began to appear?

A ANA titer 1:1024

B Anticentromere antibody titer 1:512
C CD4+ lymphocyte count 102/µL
D Positive HLA-B27
E Total serum globulin level 650 mg/dL
Q 5) In epidemiologic studies of HIV infection and AIDS, investigators noticed that
certain individuals did not develop HIV infection despite known exposure to the virus
under conditions that caused HIV disease in all other individuals similarly exposed. When
CD4+ lymphocytes from resistant individuals are incubated with HIV-1, they fail to
become infected.
Such resistance to infection by HIV is most likely caused by a mutation affecting genes for
which of the following cellular components?

A CD28 receptor
B Chemokine receptor
C Fc receptor
D Interleukin-2 receptor
E T cell receptor

Q 6) An epidemiologic study is conducted to determine risk factors for HIV infection.

The study documents that individuals with coexisting sexually transmitted diseases
such as chancroid are more likely to become HIV-positive. It is postulated that an
inflamed mucosal surface is an ideal location for the transmission of HIV during
sexual intercourse. Which of the following cells in these mucosal surfaces is most
instrumental in transmitting HIV to CD4+ T lymphocytes?

A CD8+ cells
B Langerhans cells
C Natural killer cells
D Neutrophils
E Plasma cells
 Q 7) A 34-year-old woman infected with HIV begins to have difficulty with activities
of daily living. She has memory problems and decreased ability to perform functions
that require fine motor control, such as writing and painting. Her CD4+ lymphocyte
count currently is 150/µL. Which of the following cell types is most important for the
dissemination of the infection into the central nervous system?

A CD8+ lymphocyte
B Langerhans cell
C Macrophage
D Natural killer cell
E Neutrophil

Q 8) A 45-year-old man has had a fever, cough, and worsening dyspnea for the past few
days. On physical examination, his temperature is 39.2° C. Auscultation of the chest
shows decreased breath sounds over all lung fields. A bronchoalveolar lavage is
performed, and the fluid obtained yields cysts of Pneumocystis jiroveci. Laboratory
studies show a CD4+ lymphocyte count of 135/µL; total serum globulin concentration
of 2.5 g/dL; and WBC count of 7800/mm3 with 75% segmented neutrophils, 8% bands,
6% lymphocytes, 10% monocytes, and 1% eosinophils. Which of the following
serologic laboratory findings is most likely to be positive in this patient?

A Antibodies to HIV
B Anti–double-stranded DNA antibody
C Anti–neutrophil cytoplasmic autoantibody
D Anti–streptolysin O
E Antibodies to lymphocytes
Q 9) A 17-year-old boy has been sexually active for the past 3 years. He
has had fever, lymphadenopathy, and pharyngitis for the past 3 weeks.
Serologic testing shows that he is HIVpositive. He is now currently
healthy and is not an intravenous drug user. Which of the following is the
most likely outcome of his disease within the next year?

A Appearance of an extranodal non-Hodgkin lymphoma

B Development of cryptococcal meningitis
C Seronegativity with repeat HIV testing
D Transmission of infection with unprotected sex
E Worsening cognitive and motor function

Q 10) A 37-year-old man who is HIV-positive has noticed an increasing number and
size of skin lesions on his face, trunk, and extremities, as shown in the figure, over the
past 18 months.
Some of the larger lesions appear to be nodular. Molecular analysis of the spindle cells
found in these skin lesions is likely to reveal the genome of which of the following
viruses?

A Adenovirus
B Cytomegalovirus
C Epstein-Barr virus
D HIV-1
E Human herpesvirus-8
Q 11 ) A 40-year-old man has been infected with HIV for the past 10
years. During this time, he has had several bouts of oral candidiasis, but
no major illnesses. He is now diagnosed with Kaposi sarcoma involving
the skin. He has had a 7-kg weight loss in the past 6 months. Laboratory
studies show the
HIV-1 RNA viral load is currently 60,000 copies/mL. Which of the
following types of cells is most depleted in his lymph nodes?

A CD4+ lymphocyte
B CD8+ lymphocyte
C CD19+ lymphocyte
D Macrophage
E Natural killer cell
F Plasma cell

Q 12) An epidemiologic study is conducted with children

ages 1 to 5 years who are infected with HIV-1. Most of these
children have CD4+ lymphocyte counts above 500/mm3 and
undetectable plasma HIV-1 RNA levels. On physical examination they
have no abnormal findings. What is the most likely mode of
transmission by which these children get infected?

A Breast-feeding
B Inhalation of droplet nuclei
C Fecal-oral contact
D Transfer across placenta
E Sexual abuse
Q 13) A 31-year-old HIV-positive man has had increasing respiratory difficulty for the
past 2 days. On physical examination, crackles are auscultated over all lung fields. A
chest radiograph shows bilateral interstitial infiltrates. Laboratory studies show 26,800
copies of HIV-1 RNA/mL. A transbronchial biopsy is performed; the microscopic
appearance of the specimen is shown in the figure. Which of the following is the most
likely causative organism of his pulmonary disease?

A Adenovirus
B Cytomegalovirus
C Epstein-Barr virus
D Herpes zoster virus
E Respiratory syncytial virus

Q 14) A 41-year-old man has had worsening fever, cough, and dyspnea for 2 weeks.
On examination, he has rales and diminished breath sounds on auscultation of his
chest. A chest radiograph shows scattered infiltrates in both lungs. A tuberculin skin
test shows 6 mm of induration. A sputum sample is negative, but bronchoalveolar
lavage is positive, for acid-fast bacilli. His WBC count is 4600/mm3 with differential
count of 80% neutrophils, 10% lymphocytes, and 10% monocytes. Which of the
following is the most likely risk factor for his pulmonary disease?

A Alcohol abuse
B Diabetes mellitus
C HIV infection
D Scurvy
E Smoking
 Q 15) Which of the following is an important molecule present in the
outer membrane of HIV that helps the virus to enter the host cell and
cause infection?
a) Polysaccharides
b) Glycoproteins
c) Proteins
d) Lipopolysaccharides

Q 16) Which of the following enzyme is required for the viral

replication process and plays a critical role in the pathogenesis of HIV
infection?

a) RNA polymerase
b) DNA polymerase
c) RNA polymerase II
d) Reverse transcriptase
 Q 17) The envelope protein gp120 (Glycoprotein 120) is required for the
attachment of the HIV virus to CD 4 receptors of target host cells.
Identify the immune cells that consist of CD 4 receptors:
a) T helper cells
b) Monocytes
c) Macrophages
d) Dendritic cells

Q 18) Select the correct answer, the chemokine receptor cell present in the host
macrophages that helps in the primary attachment of HIV is............................?

a) CxCR 4
b) CCR5
c) Both of the above
d) None of the above
Q 19) Which of the following is an important HIV antigen in determining the early
detection of HIV infection?

a) p24
b) gp120
c) Pol gene
d) Gp120

Q 20) Which of the following bacterial infections is predominant in

chronic HIV-infected patients or AIDS?

a) Pneumocystis carinii pneumonia

b) Tuberculosis
c) Candidiasis
d) Toxoplasmosis