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HIV Infection in Women

Epidemiology and Natural History of HIV infection in Women

1. HIV infection in children peaked between 2000 and 2002 and has slowly decreased since 2003, most dramatically in areas where:

A. There is a lower physician to patient ratio.

B. Screening and treatment of pregnant women are common.

C. Higher numbers of patients have health insurance.

D. There are free walk-in clinics.

2. In the United States the prevalence of a history of IDU is higher among younger women living with HIV compared with older women.

A. True

B. False

3. When compared with younger people, those aged 50 years and older are more likely to have clinical AIDS at the time of HIV diagnosis and they tend to have a shorter survival after diagnosis.

A. True

B. False

4. Current U.S. screening guidelines recommend routine opt-out screening of people aged:

A. 13 - 64 years

B. 12 - 59 years

C. 15 - 55 years

D. 12 - 49 years

5. In the US population as a whole, which group of women have the highest prevalence of HIV infection?

A. Black / African American

B. Hispanic / Latino

C. White

D. Native American / Alaska Natives

6. Exposure during early infection is estimated to account for half of all transmission events in North America.

A. True

B. False

7. Because genital herpes simplex is the most prevalent cause of genital ulcers and is a chronic infection, it likely has the strongest and longest duration of influence on an individual’s susceptibility to acquisition of HIV infection.

A. True

B. False

8. Among African-American women 25 - 54 years, HIV is the 2nd leading cause of death.

A. True

B. False

9. Which of the following, in the presence of HIV infection, is an AIDS-defining condition?

A. Invasive cervical cancer

B. Chronic vaginal candidiasis

C. Pelvic inflammatory disease

D. All of the above

10. It is likely that women frequently are unaware of their risk for HIV infection because that risk is related to the drug use or sexual behaviors of a male sexual partner or partners.

A. True

B. False

Approach to the Patient

11. Patients should be given written instructions that detail:

A. How to make appointments.

B. How to reach the care provider when there is a problem or when the patient has questions.

C. HIV and its treatment as well as with information about other health issues to supplement face-to-face discussions.

D. All of the above.

12. Maintaining frequent eye contact:

A. Encourages the patient’s candor.

B. Builds rapport and trust.

C. Helps allay embarrassment and fear.

D. All of the above.

13. Although different circumstances may dictate different levels of formality, addressing a patient by her first name or by terms of endearment will usually make her feel more comfortable with the care provider.

A. True

B. False

14. All States require reporting of AIDS cases, and in all 50 States, the District of Columbia, and six dependent areas, HIV cases are reported confidentially by name.

A. True

B. False

15. The expertise needed to provide care for women with HIV includes:

A. Specialists in HIV medicine, including management of ART

B. Counseling

C. Social service assistance and case management

D. All of the above

16. Which of the following is one of the few factors that has been shown over time to increase the likelihood that a patient will receive effective ART and to prolong the life of people with HIV infection?

A. Support from family and peers

B. The involvement of peer counselors

C. Care provider experience

D. Having health insurance

17. A spiritual history should include all of the following, except for:

A. Specific questions about the patient’s faith or beliefs.

B. Encouragement for her to join a faith community if she is not already part of one.

C. Her involvement in a spiritual or religious community and its importance to her.

D. Ways in which the healthcare provider may be able to help the patient integrate her beliefs and spiritual concerns into her care.

18. The initial medical evaluation of an HIV infected woman should include:

A. A comprehensive medical and psychosocial history and physical examination.

B. Menstrual history, sexual practices, contraception and condom use history, previous sexually transmitted and other genital tract infections, prior abnormal Pap smears, and other gynecologic illnesses or symptoms.

C. Pelvic examination and recommended laboratory testing.

D. All of the above.

Prevention of HIV Infection

19. Women who use injection drugs, but not those that use noninjection drugs, are at a higher risk of HIV and need counseling that addresses both safe sexual practices and harm-reduction strategies related to drug use.

A. True

B. False

20. As with any type of medical history taking, open-ended questions probably serve as the most effective means of eliciting information when taking a sexual history, and language should be all of the following, except for:

A. Nonchalant

B. Clear

C. Easy to understand

D. Nonjudgemental

21. All of the following are practical aspects of counseling, except for:

A. Focus the counseling session on risk reduction topics.

B. Listen and react to the patient.

C. Stick to a practiced script.

D. Avoid overambitious risk reduction plans.

22. During a limited period of interaction with a woman, the primary goal is to directly address and, ideally, have an impact on risky sexual behavior.

A. True

B. False

23. The most common error made by counselors is:

A. Nodding supportively to just about any statement that the patient may make in an effort to be nonjudgmental.

B. Developing an overambitious risk reduction goal.

C. Conveying urgency regarding risk.

D. Not giving the patient written documentation of the risk reduction plan.

24. Important messages for preventing sexual HIV transmission include:

A. The importance of knowing one’s HIV status and that of one’s sexual partner(s).

B. The effectiveness of behavioral change in preventing transmission.

C. The potential role of consistent condom use in significantly reducing risk of HIV transmission.

D. All of the above.

25. Experts have increasingly favored recommendations for universal HIV screening, as it is estimated that 1 in _____ HIV infected persons in the United States is unaware of his or her HIV serostatus.

A. 3

B. 5

C. 8

D. 10

26. To increase routine HIV testing as a part of routine medical practice, the target populations for opt-out testing are:

A. All pregnant women

B. Everyone initiating TB treatment

C. Everyone seeking treatment for STIs

D. All of the above

27. The 2006 CDC guidelines indicate that prevention counseling should be required as part of HIV screening programs in healthcare settings.

A. True

B. False

28. All of the following are true with regard to male circumcision, except for:

A. The foreskin contains large numbers of HIV target cells poorly protected by thin keratinized epithelium, and micro- and macroulceration of the foreskin may provide a portal of HIV entry.

B. Sex during wound healing after circumcision may increase the risk of transmission from a man to his female partner.

C. Male circumcision leads to a direct reduction in male-to-female HIV transmission.

D. Circumcision substantially reduces HIV acquisition among men, thereby potentially decreasing the likelihood that a woman will encounter an HIV infected male partner.

29. Which of the following is a measure to reduce STIs?

A. Encourage male and female condom use.

B. Encourage early medical care for diagnosis and treatment of genital tract symptoms.

C. Provide routine screening for genital tract infections among sexually active women.

D. All of the above.

30. For those with undetectable plasma viral loads, ART completely eliminates transmission risk.

A. True

B. False

31. PrEP should be delivered as part of a comprehensive set of prevention services, including risk-reduction and ready access to condoms.

A. True

B. False

32. All of the following are true with regard to PEP, except for:

A. PEP should not be administered for exposures with low transmission risk.

B. PEP should not be administered when care is sought beyond the period of 72 hours postexposure.

C. PEP should be considered a form of primary HIV prevention.

D. PEP should be considered strongly for persons who have been sexually assaulted or when a condom break during sex occurs in an HIV serodiscordant couple.

Primary Medical Care

33. Recent data have indicated that women may have lower HIV viral loads than men with an equivalent degree of immunosuppression which confers benefit in terms of overall survival and complication-free survival.

A. True

B. False

34. The average time from transmission to a reactive enzyme immunoassay is:

A. 10 - 14 days

B. 3 - 4 weeks

C. 2 - 3 months

D. 6 months

35. A cause of indeterminate test results is:

A. Seroconversion

B. Cross-reactive allo-antibodies from pregnancy, blood transfusion, or organ transplantation

C. Previous receipt of an experimental HIV vaccine

D. Any of the above

36. For a woman with indeterminate test results, it is recommended to repeat serology at all of the following time points, except for:

A. 1 month

B. 2 months

C. 4 months

D. 6 months

37. Acute HIV infection should be suspected if high-risk exposure during the previous 3 - 4 weeks is accompanied by typical symptoms, including all of the following, except for:

A. Rash

B. Diarrhea

C. Pharyngitis

D. Lymphadenopathy

38. If therapy is initiated at a low CD4+ cell count or at an older age, the increase in CD4+ cells may be blunted, even with appropriate virologic suppression.

A. True

B. False

39. The purpose of resistance assays is to inform treatment decision in the case of possible:

A. Transmitted drug resistance

B. Virologic failure

C. Suboptimal viral load reduction

D. All of the above

40. Because of an increased risk of HIV-associated nephropathy, a urinalysis / calculated creatinine clearance test is particularly important for White HIV infected patients and patients with advanced disease or comorbid conditions.

A. True

B. False

41. The primary goals of ART are all of the following, except:

A. Eradication of HIV infection.

B. Restore and preserve immune function.

C. Maximally and durably suppress HIV VL.

D. Prevent HIV transmission.

42. Which of the following noncompetitively inhibit HIV reverse transcriptase by binding to a site distant from the enzyme’s active site?

A. Nucleoside reverse transcriptase inhibitors

B. Non-nucleoside reverse transcriptase inhibitors

C. Protease inhibitors

D. All of the above

43. Which of the following directly determine the amount of a medication that is required to inhibit the patient’s virus?

A. Genotypic assays

B. Phenotypic assays

C. Both (A) and (B)

D. None of the above

44. Both HIV-associated and non-HIV-associated outcomes are worse when treatment is interrupted, therefore, long-term interruption of HIV therapy should be avoided if at all possible.

A. True

B. False

45. The appearance of _____ is often the first clinical indication of impaired T-cell immunity in HIV infected individuals.

A. Mucosal candidiasis

B. Pneumocystis jirovicii Pneumonia

C. Tuberculosis

D. Toxoplasmosis

46. Which of the following is one of the most common HIV-related opportunistic infections in the world?

A. Mucosal candidiasis

B. Pneumocystis jirovicii Pneumonia

C. Tuberculosis

D. Toxoplasmosis

Adherence to HIV Treatment and Retention in Care

47. Early in the course of treatment, and particularly if ART is started in advanced immunosuppression, a patient may worsen clinically if she has an underlying opportunistic infection that is “unmasked” or worsened after initiation of ART, a phenomenon known as immune-reconstitution inflammatory syndrome and is considered clinical failure.

A. True

B. False

48. Recent studies of boosted protease inhibitors have shown that adherence levels of _____ may be sufficient.

A. Greater than 95%

B. 80% or greater

C. 60% or greater

D. At least 50%

49. Rates of adherence significantly decrease in the postpartum period for all of the following reasons, except for:

A. The medication side effects such as nausea.

B. The inherent chaos of life when caring for a newborn.

C. The additional burden of administering ARV prophylaxis during the first 6 weeks of life.

D. The effects of postpartum depression.

International Perspectives

50. The highest adult HIV prevalence worldwide is in _____, where 1 in 4 people between ages 15 and 49 - and 42% of pregnant women - are living with HIV.

A. Swaziland

B. Zimbabwe

C. Zambia

D. Botswana

51. Placental malaria is associated with increased risk of mother-to-child transmission of HIV.

A. True

B. False

52. Essential to expansion of services for HIV prevention, care, and treatment in many LMICs is the allocation of clinical tasks to cadres of healthcare workers, who may include which of the following?

A. HIV infected women who have gone through prevention of mother-to-child transmission programs themselves and are then trained to provide peer counseling to other HIV infected pregnant women.

B. Nurses who perform voluntary medical male circumcision.

C. High school graduates who are trained to perform smear microscopy to diagnose TB.

D. All of the above.

53. A recent study from Malawi found that paying school fees for adolescent girls and providing the girls and their families with a small amount of discretionary income, as little as _____ USD per month, reduced HIV acquisition by 50% and herpes simplex virus-2 acquisition by 75% among school going adolescent girls, who were less likely to engage in transactional sex.

A. $4

B. $25

C. $100

D. $250

54. Compared with Pap smear, visual inspection with acetic acid general has all of the following, except for:

A. High negative predictive value.

B. Low positive predictive value.

C. Lower sensitivity.

D. Lower specificity.

55. Which of the following is a common challenge of ARV provision in many countries?

A. Refrigeration requirement for some formulations where electricity and refrigeration are not widely available.

B. Limited number of healthcare providers in general and, in particular, few who are able to prescribe ART.

C. Inadequate training and mentorship in prescribing ART.

D. All of the above.

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