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HIV AIDS Clinical Care - Testing and Assessment

Initial History

1. Conducting a thorough initial history and physical examination is important even if previous medical records are available.

A. True

B. False

2. If the patient has ever had syphilis, they should be asked about:

A. The stage

B. The treatment and date of treatment

C. The titer follow-up and date and result of last titer

D. All of the above

3. For men who have sex with men, they should be asked if they are the receptive or insertive partner, or both.

A. True

B. False

4. Which of the following should be reviewed with each patient?

A. The disease course.

B. The significance of CD4 cell count and HIV viral load.

C. Discloser, such as whom the patient may need to tell about their HIV status, relevant legal requirements, and approaches to disclose.

D. All of the above.

Initial Physical Examination

5. All of the following should be recorded at each visit, except for:

A. Weight

B. Height

C. Respiratory rate

D. Oxygen saturation

6. The patient should be referred to an ophthalmologist for a retinal examination every 6 months if their CD4 count is:

A. <50 cells/uL

B. <100 cells/uL

C. <150 cells/uL

D. <200 cells/uL

Initial and Interim Laboratory and Other Tests

7. The rationale for a CD4 count is all of the following, except:

A. For diagnosing HIV.

B. Helps guide urgency of ART initiation.

C. Indicates risk of opportunistic illnesses and guides initiation of prophylaxis against opportunistic infections.

D. Used to monitor immune reconstitution during ART.

8. The quantitative plasma HIV RNA (HIV viral load) should be performed every 4 - 8 weeks for which of the following?

A. Patients not taking ART.

B. Patients on stable ART.

C. Patients on new or modified ART regimen.

D. All of the above.

9. Which of the following tests indicates immunity status of Hepatitis B?

A. Hepatitis B Surface Antigen (HBsAg)

B. Hepatitis B Core Antibody (Anti-HBc, IgG)

C. Hepatitis B Surface Antibody (Anti-HBs)

D. All of the above

HIV Classification: CDC and WHO Staging Systems

10. The definition of AIDS includes all HIV-infected individuals with CD4 counts of <500 cells/uL (or CD4 percentage <14%) as well as those with certain HIV-related conditions and symptoms.

A. True

B. False

11. According to the CDC categorization, if a patient had a condition that once met the criteria for category B but now is asymptomatic, the patient would remain in category B.

A. True

B. False

CD4 and Viral Load Monitoring

12. The CD4 count is used to:

A. Stage the patient’s disease.

B. Determine the risk of opportunistic illnesses.

C. Guide decisions about the urgency of starting antiretroviral therapy.

D. All of the above.

13. Because CD4 counts do not typically vary, treatment decisions can be made on the basis of a single CD4 value.

A. True

B. False

14. In a person with untreated HIV infection, the CD4 count declines by approximately _______ cells/uL per year, on average.

A. 10 - 20

B. 30 - 50

C. 50 - 80

D. 100

15. Current United States guidelines recommend treatment for all HIV-infected individuals regardless of CD4 count.

A. True

B. False

16. Effective ART typically results in CD4 count increases of _______ within weeks after viral suppression.

A. >20 cells/uL

B. >50 cells/uL

C. >80 cells/uL

D. >100 cells/uL

17. Because HIV ultimately resides within cells, the plasma measurement is not an accurate reflection of the burden of infection and the magnitude of viral replication.

A. True

B. False

18. A viral load below the “undetectable” level indicates the absence or clearance of the virus from the body.

A. True

B. False

19. Higher plasma viral loads are associated with:

A. More rapid declines in CD4 cells.

B. Increased risk of progression to symptomatic disease and AIDS.

C. Higher risk of HIV transmission.

D. All of the above.

Risk of HIV Progression / Indications for ART

20. According to the HHS guidelines, which of the following factors or coexisting conditions signal the need for speedier initiation of therapy?

A. Pregnancy

B. Acute opportunistic infections

C. Acute / recent HIV infection

D. All of the above

Early HIV Infection

21. During the acute stage of HIV infection, patients typically have all of the following, except:

A. Symptoms of acute retroviral illness.

B. HIV RNA levels >100,000 copies/mL.

C. Positive HIV antibody test results.

D. Detectable p24 antigen.

22. After infection with HIV, it takes a median of about _______ before the HIV antibodies are detectable in most people.

A. 25 days

B. 8 weeks

C. 4 months

D. 6 months

23. Which of the following is a symptom of acute retroviral syndrome that typically appears  2 - 6 weeks after exposure to HIV?

A. Fever

B. Rash

C. Fatigue

D. All of the above

24. Generalized lymphadenopathy, rash, thrush, and mucosal ulceration are sufficiently uncommon in most adult febrile illnesses that, when present, they should trigger suspicion of acute HIV infection.

A. True

B. False

25. The potential advantages of ART for primary infection must be weighed against each of the following, except for:

A. The possibility of short- and long-term toxicities.

B. The possibility that the patient will not return for follow up lab work.

C. The possibility of developing drug resistance.

D. The adherence challenges associated with starting ART quickly for newly diagnosed patients.

26. For pregnant women with acute or recent HIV, the risk of perinatal HIV transmission is very high; thus, ART should be started as early as possible to try to prevent infection of the infant.

A. True

B. False

Expedited HIV Testing

27. The negative predictive value of all rapid and expedited HIV tests is close to:

A. 100%

B. 90%

C. 80%

D. 70%

28. The high specificity of the rapid or expedited tests means that, if a test result is positive, the likelihood that a client is truly HIV infected depends on the local HIV prevalence.

A. True

B. False

Resistance Testing

29. Genotype testing will predict which antiretroviral drugs will be active in a particular patient.

A. True

B. False

30. Unknowingly starting a patient on ARV medications to which his or her virus is already resistant may risk failure of the initial regimen, rapid acquisition of additional resistance mutations, and curtailment of future treatment options.

A. True

B. False

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