HIV/AIDS and Infections (Dengue, COVID-19, Opportunistic Infections) MCQs

Medicine · 88 free questions with answers & explanations.

  1. A 32-year-old HIV-positive man (CD4 count 45 cells/μL, viral load detectable) presents with painless visual field loss in his right eye. Fundoscopy shows perivascular hemorrhages and exudates with a 'pizza-pie' or 'tomato-ketchup' appearance. What is the most likely diagnosis and treatment?
  2. A 25-year-old man returns from a dengue-endemic area with 5 days of high fever, severe headache, retroorbital pain, and myalgia. His platelet count has dropped from 180,000 to 42,000/μL. He has no bleeding but shows a positive tourniquet test. What is the most appropriate management?
  3. A 35-year-old man with HIV (CD4 count 45 cells/μL, viral load 120,000 copies/mL) presents with painless progressive vision loss in the right eye. Fundoscopy shows white granular retinal lesions with hemorrhages in a 'pizza pie' or 'cottage cheese and ketchup' pattern along the vascular arcades. What is the most likely diagnosis and first-line treatment?
  4. A 28-year-old previously healthy man presents on day 4 of dengue fever with severe abdominal pain, persistent vomiting, and clinical warning signs. BP is 100/70 mmHg, pulse 108 bpm. Hematocrit has risen from 38% to 48% (rise >20%). Platelets are 58,000/μL. What phase of dengue is he in and what does the hemoconcentration indicate?
  5. A 35-year-old HIV-positive patient (CD4 count 28 cells/μL) presents with 3 weeks of progressive cognitive decline, headache, and focal neurological signs. MRI brain shows multiple ring-enhancing lesions with mass effect in the basal ganglia and thalamus. CSF PCR is pending. What is the most appropriate empiric therapy while awaiting results?
  6. A 28-year-old woman presents on day 5 of dengue fever with severe abdominal pain, persistent vomiting, and bleeding gums. Platelet count has dropped to 18,000/μL. Haematocrit is rising (from 38% to 44%). Blood pressure is 95/65 mmHg. What is the WHO dengue severity classification of this patient, and what is the immediate management?
  7. Co-receptor usage by HIV-1 determines cell tropism. Macrophage-tropic (M-tropic, R5) HIV strains use CCR5 as the co-receptor. The natural resistance of homozygous CCR5-Δ32 mutation (deletion of 32 bp) individuals to HIV infection inspired which therapeutic drug?
  8. In Dengue haemorrhagic fever, plasma leakage and thrombocytopaenia result partly from antibody-dependent enhancement (ADE). Platelet activation and endothelial damage by dengue also involve NS1 protein. At which platelet count threshold does the WHO recommend therapeutic platelet transfusion in stable DHF?
  9. Immune reconstitution inflammatory syndrome (IRIS) in HIV patients initiating ART is most commonly associated with which opportunistic infection, often presenting as paradoxical worsening after starting ART?
  10. A 30-year-old HIV-positive patient (CD4 count 180 cells/μL, viral load 45,000 copies/mL) is about to start ART. He is coinfected with hepatitis B virus (HBsAg positive, HBV DNA 8 × 10⁵ IU/mL). The MOST appropriate ART regimen is:
  11. A 32-year-old returns from Southeast Asia with a 5-day febrile illness. On day 5, fever breaks and she develops dengue warning signs: abdominal pain, vomiting, bleeding gums, lethargy, and haematocrit rise from 38% to 47% with platelet count 28,000/μL. The CORRECT management step is:
  12. A patient with HIV (CD4 count 60 cells/μL) develops a painful vesicular rash over the T5-T7 dermatome on the right side. Cranial nerve involvement is NOT present. The MOST appropriate antiviral treatment is:
  13. A 36-year-old man with HIV infection (CD4 count 45 cells/µL) on ART for 3 months presents with headache, fever, and neck stiffness. CSF shows elevated pressure (28 cmH2O), lymphocytic pleocytosis (85 cells), protein 85 mg/dL, and glucose 45 mg/dL. India ink preparation is positive and CSF cryptococcal antigen (CrAg) is strongly positive (1:2048). The ASTRO-CM and ACTA trial-based optimal induction regimen for cryptococcal meningitis in HIV is:
  14. A patient with COVID-19 pneumonia is on high-flow nasal oxygen at 40 L/min with FiO2 0.6 (SpO2 93%). He is day 8 of illness. According to WHO Solidarity and RECOVERY trial findings, what is the optimal pharmacological treatment at this stage?
  15. A 35-year-old man newly diagnosed with HIV has CD4 count of 85/μL and HIV RNA of 320,000 copies/mL. He presents with fever, weight loss, and night sweats but no focal neurological signs. Urine Cryptococcal Antigen (CrAg) is positive by lateral flow assay. Serum CrAg is also positive. CSF examination is pending. How should cryptococcal antigenemia in HIV be managed per WHO 2022 guidelines, if the lumbar puncture is NEGATIVE for meningitis?
  16. A 40-year-old man with HIV (CD4 30/μL) on ART develops progressive multifocal leukoencephalopathy (PML) confirmed by JC virus PCR in CSF. What is the primary treatment strategy for PML in HIV?
  17. A 32-year-old HIV-positive man with CD4 count 45 cells/µL presents with progressive bilateral headache, fever, and confusion over 2 weeks. CSF analysis: opening pressure 28 cmH₂O, glucose 38 mg/dL, protein 68 mg/dL, lymphocytes 12/µL, India ink positive. Which component of initial management has the strongest evidence for reducing acute mortality?
  18. A 28-year-old newly diagnosed HIV-positive individual (CD4 580 cells/µL, VL 45,000 copies/mL) with no OIs is ready to start ART. Which combination regimen is preferred per WHO 2021 and DHHS 2022 guidelines?
  19. A 32-year-old man is newly diagnosed with HIV infection. CD4 count is 180 cells/μL, HIV RNA is 85,000 copies/mL. He has no opportunistic infections. HLA-B*57:01 testing is negative. According to current WHO/DHHS 2023 guidelines, the preferred first-line antiretroviral regimen is:
  20. A 28-year-old man with HIV (CD4 32 cells/μL, not on ART) develops fever, severe headache, and meningismus. CSF: opening pressure 320 mmH2O, WBC 8 cells/μL (lymphocytes), glucose 32 mg/dL, protein 95 mg/dL, India ink positive, CSF cryptococcal antigen titre 1:512. The most critical initial management step based on recent AMBITION clinical trial data is:
  21. A 38-year-old HIV-positive man (CD4 28 cells/µL, viral load 120,000 copies/mL) presents with headache, fever, and photophobia. CSF shows opening pressure 28 cmH2O, lymphocytic pleocytosis, and India ink positive budding yeast. CSF cryptococcal antigen (CrAg) is positive 1:1024. The induction regimen of choice is:
  22. A 25-year-old returns from Southeast Asia with 3 days of high fever, retro-orbital headache, myalgia, and rash. CBC shows platelets 68,000/µL, WBC 2.8 × 10³/µL, hematocrit 42% (baseline 38% 6 months ago). NS1 antigen is positive. At what platelet count threshold does the WHO recommend platelet transfusion in dengue WITHOUT spontaneous bleeding?
  23. A 45-year-old HIV-positive man on ART with undetectable viral load and CD4 count 180 cells/µL develops new fever, nonproductive cough, and weight loss over 6 weeks. CXR shows miliary infiltrates. Serum LDH is elevated. Sputum AFB smear is negative × 3. The best diagnostic test to confirm disseminated Mycobacterium avium complex (MAC) is:
  24. A 32-year-old man is newly diagnosed with HIV infection. CD4 count is 380 cells/µL and HIV viral load is 45,000 copies/mL. He has no active opportunistic infections. He is willing to start antiretroviral therapy. According to current WHO 2023 and DHHS guidelines, when should ART be initiated?
  25. A 25-year-old man presents on day 3 of illness with high fever, severe headache, retroorbital pain, and myalgia. Tourniquet test is positive. CBC: WBC 3,200/µL, platelets 88,000/µL, haematocrit 46%. NS1 antigen is positive. He is alert and haemodynamically stable. Which dengue category and warning sign assessment is most critical at this stage?
  26. A 35-year-old man newly diagnosed with HIV has CD4 count 180 cells/μL and HIV RNA 85,000 copies/mL. He has no prior ART exposure. According to current WHO 2024 and DHHS 2024 guidelines, regarding timing of ART initiation:
  27. A 40-year-old woman presents with 5 days of fever (40°C), severe myalgia, retro-orbital pain, and a positive NS1 antigen test. On day 6, platelet count drops from 150,000 to 42,000/μL. She develops abdominal pain and her haematocrit rises from 38% to 46%. She remains haemodynamically stable with BP 100/70 mmHg and good urine output. The WHO dengue classification and appropriate management is:
  28. Current WHO and DHHS 2024 guidelines recommend initiating antiretroviral therapy (ART) in all newly diagnosed HIV-positive individuals regardless of CD4 count. Which two-drug regimen is now approved as a complete regimen for HIV treatment (not just maintenance) in virologically suppressed patients?
  29. Severe dengue (dengue haemorrhagic fever/dengue shock syndrome) is characterised by plasma leakage. The WHO 2009 dengue classification includes 'dengue with warning signs.' Which warning sign is the STRONGEST predictor of severe dengue requiring hospitalisation?
  30. A 35-year-old man with HIV and CD4 count of 60 cells/μL presents with headache, fever, and meningismus. CSF opening pressure is 340 mmH₂O. India ink preparation of CSF shows encapsulated yeast. The diagnosis is cryptococcal meningitis. Induction therapy per WHO guidelines is:
  31. A 30-year-old HIV-positive man (CD4 45 cells/μL, HIV RNA 200,000 copies/mL) is about to start antiretroviral therapy. He also tests positive for latent tuberculosis (positive IGRA). According to current guidelines on timing of ART initiation in TB/HIV coinfection:
  32. A 28-year-old returning from SE Asia has fever, severe headache, retro-orbital pain, and a positive tourniquet test. Platelet count is 48,000/μL, haematocrit has risen by 22% from baseline. NS1 antigen is positive. This is dengue with warning signs. Which feature would indicate SEVERE dengue requiring ICU admission per WHO 2009 criteria?
  33. A 35-year-old HIV-positive patient (CD4 count 52 cells/µL, not on ART) develops headache, fever, and mild neck stiffness over 3 weeks. CSF India ink preparation shows encapsulated yeast. CSF cryptococcal antigen is positive at 1:1024. What is the induction regimen of choice?
  34. A patient with dengue fever on day 5 of illness has: platelet count 18,000/µL, hematocrit 48% (baseline 38%), BP 90/60 mmHg, cold extremities, and pleural effusion on CXR. According to WHO classification, what stage is this and what is the most critical immediate intervention?
  35. A 34-year-old HIV-positive man with CD4 count 48 cells/µL and viral load 180,000 copies/mL presents with progressive headache, fever and altered consciousness. CSF shows opening pressure 280 mmHg, WBC 12 cells/µL (predominantly lymphocytes), protein 85 mg/dL, glucose 30 mg/dL (serum glucose 90 mg/dL). India ink preparation shows encapsulated yeast. The treatment of choice for induction is:
  36. A 28-year-old man presents with 5 days of high fever, severe headache, retroorbital pain, myalgia and macular rash. WBC 2.4 × 10⁹/L, platelet count 68 × 10⁹/L, haematocrit 46%. NS1 antigen is positive on day 2 of fever. By day 6 the platelet count falls to 18 × 10⁹/L with haematocrit rising to 52% and the patient develops restlessness and abdominal pain. According to WHO 2009 dengue classification, this patient is classified as:
  37. A 35-year-old HIV-positive man (CD4 45 cells/μL, viral load 180,000 copies/mL) presents with severe headache, photophobia, and progressive confusion for 2 weeks. CSF analysis reveals India ink positivity, CSF glucose 30 mg/dL, protein 90 mg/dL, WBC 20 cells/mm³. Cryptococcal antigen is positive. What is the standard induction regimen per IDSA 2010 guidelines?
  38. A 28-year-old woman is newly diagnosed with HIV (CD4 380 cells/μL, viral load 55,000 copies/mL). She is HBsAg-positive. Which antiretroviral regimen is preferred, accounting for her hepatitis B coinfection?
  39. A 35-year-old man from a dengue-endemic area presents on day 3 of fever with myalgia, retro-orbital pain, platelet count 68 × 10⁹/L, leukopenia, and a positive dengue NS1 antigen. On day 5, he develops abdominal pain, persistent vomiting, and clinical signs of fluid accumulation. BP 100/70. This phase of dengue is characterized by:
  40. A 35-year-old HIV-positive man (CD4 count 55 cells/µL, not on ART) presents with 3 weeks of headache, fever, and neck stiffness. CSF analysis shows: opening pressure 28 cmH2O, glucose 30 mg/dL, protein 95 mg/dL, WBC 8 cells/µL (lymphocytes). India ink stain is positive and CSF cryptococcal antigen (CrAg) titre is 1:1024. The initial induction regimen per WHO/IDSA guidelines is:
  41. A 28-year-old woman returns from Southeast Asia with 5 days of fever, severe headache, retro-orbital pain, and myalgia. She develops spontaneous gum bleeding on day 5. CBC shows: WBC 2800/µL, Hb 12 g/dL, platelets 38,000/µL. NS1 antigen is positive. Dengue NS1 is detectable at what stage of illness?
  42. A 32-year-old man newly diagnosed with HIV infection has CD4 count 410 cells/μL and viral load 42,000 copies/mL. He has no active opportunistic infections. Which statement about antiretroviral therapy initiation is MOST accurate per current WHO/DHHS guidelines?
  43. A 24-year-old man returns from an endemic region with 5-day history of high fever, severe headache, retro-orbital pain, myalgia, and a maculopapular rash. Total WBC is 2,800/μL, platelets 68,000/μL. Dengue NS1 antigen is positive. On day 5, he develops rising haematocrit (HCT 52%, baseline 42%), ascites, and bilateral pleural effusions. His BP drops to 90/60 mmHg. What is the MOST appropriate immediate management?
  44. A 34-year-old man with HIV (CD4 count 58 cells/µL, not on ART) develops fever, headache, and neck stiffness. CSF: opening pressure 380 mmH₂O, lymphocytic pleocytosis, low glucose, high protein. India ink preparation is positive. What is the treatment protocol?
  45. A 28-year-old HIV-positive man with CD4 count 42 cells/µL has a new headache and is found to have a single ring-enhancing lesion in the right basal ganglia on MRI. Toxoplasma IgG is positive. CSF PCR for T. gondii is positive. What empirical therapy should be started?
  46. A 25-year-old man returns from a dengue-endemic area with high fever for 4 days, retro-orbital pain, myalgia, and a petechial rash. Platelet count is 52,000/µL. NS1 antigen is positive. On day 5, fever defervesces but he develops abdominal pain, increasing haematocrit (from 38% to 49%), and a small pleural effusion. What phase of dengue is this and what is the most critical management parameter?
  47. A 32-year-old HIV-positive man (CD4 52 cells/µL, viral load 85,000 copies/mL) is naive to antiretroviral therapy. He has no resistance mutations on genotype. According to WHO and DHHS 2024 guidelines, which preferred first-line ART regimen should be initiated?
  48. A 26-year-old man presents with 5 days of high fever, severe headache, retro-orbital pain, myalgia, and a macular rash on day 4. Platelet count is 68,000/µL, AST 180 U/L, haematocrit rising. NS1 antigen is positive. His dengue rapid test shows NS1+, IgM−, IgG−. According to WHO 2009 dengue classification, he is classified as:
  49. A 55-year-old man with COVID-19 pneumonia (SpO₂ 88% on room air, CRP 145 mg/L, ferritin 1820 ng/mL) is hospitalised and requires supplemental oxygen. According to the WHO and RECOVERY trial data, the treatment that reduces 28-day mortality in this patient is:
  50. A 35-year-old HIV-positive man on ART with CD4 count of 85 cells/µL develops fever, cough, and bilateral interstitial infiltrates. LDH is 620 IU/L. Bronchoalveolar lavage with silver staining shows cysts. He is started on cotrimoxazole. At which CD4 threshold should cotrimoxazole primary prophylaxis for PCP have been initiated?
  51. A 30-year-old man presents with 5 days of high fever, severe myalgia, retro-orbital pain, and a petechial rash. Platelet count has dropped from 160,000 to 48,000/µL over 3 days. NS1 antigen is positive. He has no warning signs. Which clinical parameter, if present, would mandate hospital admission per WHO dengue classification?
  52. A 35-year-old HIV-positive man (CD4 count 45/μL, viral load 85,000 copies/mL) presents with headache, fever, and altered sensorium. CSF reveals elevated opening pressure, India ink positive, and cryptococcal antigen titre of 1:1024. Which is the preferred induction regimen for HIV-associated cryptococcal meningitis per WHO 2022 guidelines?
  53. A 30-year-old HIV-positive woman (CD4 550/μL, no prior ART) develops active pulmonary tuberculosis. She is started on RIPE (Rifampicin-INH-Pyrazinamide-Ethambutol). When should antiretroviral therapy (ART) be initiated?
  54. A 34-year-old HIV-positive man (CD4 80 cells/μL, not on ART) presents with headache, fever, and altered sensorium. CSF shows India ink positive encapsulated yeast, CSF opening pressure 32 cm H₂O, CSF cryptococcal antigen titre 1:512. Which management step is critical in the first 2 weeks beyond antifungal therapy?
  55. A 28-year-old man presents on day 3 of dengue fever with fever, severe myalgia, thrombocytopaenia (platelet count 65,000/μL), haematocrit rise of 18% from baseline, and clinical evidence of plasma leakage (bilateral pleural effusions). According to WHO dengue classification, what is his category and does he need hospitalisation?
  56. A 44-year-old HIV-positive woman (CD4 count 200 cells/μL) is started on ART. Three weeks later she develops high fever, cervical lymphadenopathy, and mediastinal lymph nodes on CXR. Sputum AFB is positive. She was diagnosed with TB 1 month ago and started on ATT. What is the most likely diagnosis and the recommended approach?
  57. A 35-year-old HIV-positive man (CD4 45/µL, viral load 120,000 copies/mL) develops bilateral diffuse interstitial infiltrates, progressive hypoxia (PaO₂ 56 mmHg on room air), and an elevated serum LDH. BAL shows Pneumocystis jirovecii. What is the treatment and the indication for adjunctive corticosteroids?
  58. A 32-year-old HIV-negative gay man presents requesting pre-exposure prophylaxis (PrEP). He has a high-risk sexual partner and negative HIV test. Per WHO/CDC guidelines, which PrEP regimen is recommended as an alternative to daily TDF/FTC for on-demand PrEP (event-driven)?
  59. A 55-year-old man returns from Southeast Asia with 10-day history of fever, chills, severe headache, and jaundice. Blood film shows ring forms and rare triple infection of erythrocytes. Parasitemia is 8%. Serum creatinine 3.1 mg/dL. The appropriate treatment for severe falciparum malaria is:
  60. A 32-year-old HIV-positive man (CD4 count 38 cells/µL, not on ART) presents with bilateral visual impairment. Fundoscopy shows perivascular yellow-white infiltrates with haemorrhage ('pizza-pie' appearance) along the vascular arcades. What is the most likely diagnosis and treatment?
  61. A 28-year-old man recently diagnosed with HIV has a CD4 count of 180 cells/µL. He is about to start ART. At what CD4 threshold should prophylaxis for Pneumocystis jirovecii pneumonia (PJP) be started, and what is the preferred agent?
  62. A 25-year-old traveller returns from Southeast Asia with 5 days of high fever, severe headache, retro-orbital pain, and a positive NS1 antigen test. On day 5, his platelet count falls to 28,000/µL. He develops warning signs: persistent vomiting and abdominal tenderness. What is the most important management principle at this stage?
  63. A 34-year-old HIV-positive man with CD4 count 48 cells/μL presents with headache, fever, and meningism. CSF India ink preparation is positive. Cryptococcal antigen titre is 1:512. The MOST appropriate initial treatment is:
  64. A 28-year-old man in dengue-endemic area presents on day 4 of fever with platelet count 28,000/μL, haematocrit rise from 38% to 49%, positive tourniquet test, and BP 95/70 mmHg with cold extremities. According to WHO 2009 classification, this is:
  65. A 32-year-old man with HIV (CD4 count 45 cells/µL, viral load 85,000 copies/mL, not on ART) presents with painless progressive bilateral visual loss and fundoscopy reveals 'pizza pie' or 'cheese and ketchup' retinopathy with haemorrhages and exudates along vessels. CSF is normal. The MOST likely diagnosis and initial treatment is:
  66. A 28-year-old HIV-negative man returns from Southeast Asia with high fever, severe headache, and myalgia for 5 days. Tourniquet test is positive. Platelet count is 48,000/µL, haematocrit 46% (baseline 40%). NS1 antigen is positive; dengue IgM antibody is negative. He develops early signs of plasma leakage. According to WHO 2009 dengue classification, this patient is categorised as:
  67. A 35-year-old HIV-positive man with CD4 count 45 cells/µL presents with headache, fever, and confusion for 5 days. CSF shows opening pressure 280 mmH2O, glucose 35 mg/dL, protein 80 mg/dL, WBC 25 (lymphocytes), India ink stain positive, CSF cryptococcal antigen (CrAg) titer 1:1024. Per current WHO/IDSA guidelines, what is the preferred induction regimen?
  68. A 28-year-old man presents on day 4 of dengue fever. He now has persistent vomiting, abdominal pain, and hepatomegaly. BP 90/60, pulse 110, platelet 28,000/µL, hematocrit has risen from 36% to 44%. He is not bleeding. What is this stage called and what is the management?
  69. In HIV-positive patients on antiretroviral therapy (ART) who develop opportunistic infections, immune reconstitution inflammatory syndrome (IRIS) most commonly occurs at what CD4 cell count threshold and timing?
  70. Current WHO PEPFAR guidelines recommend which ART regimen as preferred first-line therapy for treatment-naive HIV-positive adults (including pregnant women)?
  71. In severe dengue, which laboratory finding best characterises the critical 'plasma leakage' phase that increases risk of dengue shock syndrome (DSS)?
  72. A 38-year-old man with HIV infection (CD4 count 88 cells/µL, viral load 68,000 copies/mL, not yet on ART) presents with progressive dyspnoea, dry cough, low-grade fever, and bilateral perihilar ground-glass infiltrates on HRCT. LDH is 480 U/L. His oxygen saturation drops to 88% on exertion. Which prophylaxis/treatment consideration is the MOST important additional adjunct to first-line TMP-SMX in moderate-to-severe PCP?
  73. A 40-year-old woman developed severe COVID-19 (SpO2 82%, ARDS criteria met, day 7 of illness). She requires mechanical ventilation. The RECOVERY trial's pivotal finding for this clinical stage was:
  74. A 35-year-old man with newly diagnosed HIV (CD4 450 cells/µL, HIV RNA 35,000 copies/mL) is starting ART. The HLA-B*5701 test is performed before initiating which drug?
  75. A patient with HIV and CD4 40 cells/µL develops headache and papilledema. CSF India ink preparation shows encapsulated yeasts. Initial antifungal therapy for cryptococcal meningitis should include:
  76. A 32-year-old man with HIV (CD4 count 62 cells/µL, viral load 180,000 copies/mL) is started on antiretroviral therapy (ART). Three weeks later he develops fever, cervical lymphadenopathy, and worsening of previously stable pulmonary infiltrates attributed to old TB. What is the diagnosis, and what is the appropriate management?
  77. A 29-year-old male with high-risk HIV exposure (receptive anal intercourse with HIV-positive partner with unknown viral load) presents 52 hours after exposure. He has no prior HIV test. What is the most appropriate management?
  78. A 36-year-old HIV-positive patient (CD4 52 cells/μL, not on ART) presents with right-sided focal neurological deficit. MRI brain shows multiple ring-enhancing lesions in the basal ganglia. Toxoplasma IgG is positive. What is the BEST initial management?
  79. A 32-year-old man presents on day 5 of dengue illness with platelet count of 22,000/μL, haematocrit rise of 22% from baseline, and pleural effusion detected on ultrasound. His pulse is 98 and BP is 105/76 mmHg. According to WHO 2009 dengue classification, how should this be classified?
  80. A 35-year-old HIV-positive man has CD4 count 42 cells/µL. He presents with fever, headache, and photophobia for 5 days. CSF opening pressure is 280 mmH2O. CSF India ink preparation is positive. CSF cryptococcal antigen titre is 1:512. What is the induction treatment and how is raised intracranial pressure managed?
  81. A 25-year-old man presents on day 5 of dengue fever with abdominal pain, vomiting, and restlessness. Platelet count drops to 42,000/µL. Haematocrit rises from 36% to 44% (> 20% increase). BP is 95/70 mmHg. What dengue phase/category is this and what is the management?
  82. A 35-year-old HIV-positive patient has a CD4 count of 45 cells/μL and is not on ART. He develops fever, night sweats, and elevated serum LDH. Chest CT shows bilateral pulmonary infiltrates. BAL lavage with Gomori methenamine silver (GMS) stain shows cup-shaped intracystic bodies. The preferred treatment for moderate-severe Pneumocystis jirovecii pneumonia (PCP) is:
  83. A 28-year-old man is newly diagnosed with HIV (CD4 280 cells/μL, viral load 250,000 copies/mL). He has active pulmonary TB. When should antiretroviral therapy (ART) be initiated relative to TB treatment per WHO/ACTG guidelines?
  84. A 36-year-old HIV-positive man with a CD4 count of 42 cells/µL and not on ART presents with fever, headache, and meningismus. CSF India ink preparation is positive. Serum cryptococcal antigen titre is 1:512. What is the recommended induction regimen for cryptococcal meningitis in this patient according to WHO 2022 guidelines?
  85. In severe dengue, which pathophysiological mechanism directly explains the development of plasma leakage and dengue shock syndrome?
  86. An HIV-positive patient with CD4 count of 65 cells/µL is started on ART. Two weeks later he develops worsening fever, lymphadenopathy, and new pulmonary infiltrates. CD4 has risen to 120 cells/µL. The MOST likely explanation is:
  87. According to WHO 2024 guidelines, which doxycycline-based post-exposure prophylaxis (doxy-PEP) is now recommended for prevention of bacterial STIs in MSM and transgender women after unprotected sexual exposure?
  88. A dengue patient develops dengue haemorrhagic fever (DHF) Grade III. Which haematological finding BEST distinguishes DHF from dengue fever?
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