Physician Assistant Infectious Diseases 2

Question 1

At what CD4 count should primary prophylaxis against Pneumocystis jirovecii pneumonia be started in a patient with HIV?

Accepted Answer

Below 200 cells/mm³

Answer

PJP prophylaxis, usually with TMP-SMX, is indicated when the CD4 count falls below 200 cells/mm³ or with oropharyngeal candidiasis.

Question 2

A patient with HIV and a CD4 count of 40 cells/mm³ has fever, weight loss, and diarrhea, and blood cultures grow acid-fast bacilli. What is the most likely organism?

Accepted Answer

Mycobacterium avium complex

Answer

Disseminated MAC typically occurs when CD4 is below 50 cells/mm³ and presents with fever, weight loss, diarrhea, and mycobacteremia.

Question 3

A patient with AIDS has headache, fever, and elevated opening pressure on lumbar puncture, and India ink stain shows encapsulated yeast. What is the preferred induction therapy?

Accepted Answer

Amphotericin B plus flucytosine

Answer

Cryptococcal meningitis induction therapy is liposomal amphotericin B plus flucytosine, followed by fluconazole consolidation.

Question 4

A patient with HIV has multiple ring-enhancing brain lesions and a positive Toxoplasma IgG. What is the first-line treatment?

Accepted Answer

Pyrimethamine, sulfadiazine, and leucovorin

Answer

CNS toxoplasmosis is treated with pyrimethamine plus sulfadiazine, with leucovorin given to prevent bone marrow suppression.

Question 5

Which HLA allele must be tested for before starting abacavir?

Accepted Answer

HLA-B*57:01

Answer

HLA-B*57:01 carriers are at high risk for a severe abacavir hypersensitivity reaction, so the drug is contraindicated in them.

Physician Assistant Practice Test

Physician Assistant Practice Test

Physician Assistant Infectious Diseases 2