Microsoft word - example questions _sep from admin guidance_.doc

DHIV SAMPLE QUESTIONS
Questions will be consistent with relevant UK guidelines (e.g. British HIV Association guidelines). This may
include reference to completed guidelines awaiting publication which are available on-line (eg www.bhiva.org),
but not to guidelines which are out for consultation.
Best of five

A 37-year-old man is admitted to hospital in the UK with severe diarrhoea for 10 days. He reports 6kg of weight loss. On examination he is moderately dehydrated, has generalised lymphadenopathy and oral candida. He is diagnosed HIV-positive on admission. He reports a negative HIV test one year ago. He is given intravenous fluids, ciprofloxacin and metronidazole. After 4 days his diarrhoea is 70% improved. Results Stool microscopy
He asks you what stage of HIV infection he has.

What is the most appropriate response to his question?

A
AIDS due to weight loss and lymphadenopathy
Answer: E (Symptomatic HIV infection)
Explanation
A
Incorrect, cryptosporidial diarrhoea is only an AIDS defining illness if present for greater than 1 month
Incorrect, CD4 count alone is not a criteria for AIDS within the UK
Incorrect, weight loss greater than 10% defines AIDS
Incorrect, timing of HIV infection may be up to 1 year previously and this is not the classical presentation
of someone with primary infection (no fever)
Correct, this is the BEST answer.
You are seeing a 38-year-old woman who has been on treatment since 1992. By 2002 she had received multiple combinations, including unboosted protease inhibitors, non-nucleoside reverse transcriptase inhibitors and nucleoside reverse transcriptase inhibitors. Since then she has been maintained on zidovudine, abacavir and KaletraTM. Results Viral load Genotypic resistance test Reverse transcriptase Which 2 drugs would be most effective in a new combination? A
Answer: E (Raltegravir and Darunavir)
Explanation
A
Incorrect, Y181C has a negative impact on susceptibility to etravirine, with a weighting of 2.5 on the
Tibotec etravirine score
Incorrect, tropism is undetermined therefore response to maraviroc cannot be predicted
Incorrect, as per option A
Incorrect, as per option A
Correct, this is the BEST of the 5 options. The woman is integrase inhibitor naïve and so raltegravir is fully
active. The 2 protease inhibitor mutations are not associated with darunavir resistance

3.
A 52-year-old, HIV-positive woman attends her routine clinic appointment. She has been on a combination of
KivexaTM and nevirapine for 8 months and has had an undetectable viral load for the last 6 months.
Baseline results (pre-treatment)

On enquiring whether she has any other problems she reports she has felt depressed and has been taking St
John’s wort for the preceding 12 weeks.
How would you best manage the potential interaction with her antiviral therapy?
A
Switch nevirapine to darunavir, ritonavir
Answer: C (Stop St John’s wort)
Explanation

Incorrect: If nevirapine levels are satisfactory this may be reassuring but they only indicate what is
happening at 1 time point. There is no guarantee of the quality control of St John’s wort and therefore
over time what the drug exposure might be.
Incorrect: St John’s wort is an enzyme inducer and may lead to sub-therapeutic levels of nevirapine
Correct: This is the BEST answer. St John’s wort is an enzyme inducer and may lead to sub-therapeutic
levels of nevirapine. Depression should be assessed and guidelines followed if drug treatment required,
taking account of drug interactions
Incorrect: There is a significant interaction with maraviroc, predicted to decrease maraviroc levels.
Incorrect: There is a significant interaction with ritonavir and darunavir predicted to decrease levels of
both drugs
OSCE

Instructions to candidates

Station title: Primary HIV infection
This station lasts 10 minutes. You are a doctor in an HIV clinic. This patient is Mrs Haddon. She is 44 years old. Four weeks ago she developed a flu-like illness with fever that persisted for one week. Following investigation she was diagnosed HIV positive. Her husband was diagnosed HIV positive when he presented with oesophageal candida two years before. Mrs Haddon last tested HIV negative one year ago. Her current Her viral load is 800,000 c/ml and her CD4 count is 350 cells/µL. She has attended your clinic to seek information and advice concerning her condition. Discuss with the patient the issues involved and answer any questions she has. There is no need to write anything down.

Source: http://www.apothecaries.org/Apothecaries/media/Media/Examinations/Example-questions-_sep-from-Admin-Guidance_v1.pdf