227 28, 2010 MIDTERM EXAMINATION KEY

Size: px

Start display at page:

Download "227 28, 2010 MIDTERM EXAMINATION KEY"

Joel Clark
5 years ago
Views:

1 Epidemiology 227 April 28, 2010 MIDTERM EXAMINATION KEY Select the best answer for the multiple choice questions. There are 64 questions and 9 pages on the examination. Each question will count one point. Notify the instructor if your examination does not have 9 pages. Clearly indicate on the scan form the one best answer to each question among the answers provided. Be sure that you have selected your choice correctly on the scan form. Be sure that you have entered your name and identification number on the scan form and filled out the columns for the letters of your name and numbers of your identification number correctly (see front and back). Use a #2 pencil and fill all circles completely. 1. Which of the following complications of HIV infection is not associated with a high risk of death? a. AIDS dementia complex b. Peripheral neuropathy c. Meningitis d. Progressive multifocal leukoencephalopathy e. All of the above are associated with a high risk of death 2. Decline in cognitive function is usually first measurable: a. Within one year of HIV infection b. Approximately one year before diagnosis of AIDS c. Within three years after diagnosis of AIDS d. Within 6 months of death 3. Diagnosis of a neurocognitive disorder depends on: a. Reported/documented interference in daily functioning b. Presence of a psychosis c. Depression d. Evidence of a change in attention and/or abstraction/learning skills e. a. and d. above 4. Although the incidence of HIV/AIDS dementia is declining, the prevalence is increasing due to: a. Increased survival of persons infected with HIV b. Better, more sensitive tools for diagnosing HIV/AIDS dementia c. Increasing awareness of HIV/AIDS dementia d. Side effects of HAART treatment 5. Immediate action that should be taken after a diagnosis of AIDS dementia includes: a. More sensitive testing to localize the lesion in the brain b. Initiation of treatment with HAART c. Referral to a psychiatrist d. Planning for custodial care of the affected individual 6. HIV causes primary dementia complex by: a. Directly infecting neurons b. Production of neurotoxins in the central nervous system c. Both of the above 1

2 7. Individuals with less education are at greater risk of cognitive impairment with HIV infection of the central nervous system: 8. The most effective treatment for HIV dementia complex is: a. High-dose AZT plus Nimodipine plus Selegiline plus Memantine b. Nimodipine plus Memantine c. High-dose AZT plus Memantine. d. High-dose AZT plus Selegiline e. HAART 9. The ability to multi-task (do more than one activity at a time) usually declines with: a. AIDS dementia complex b. Aging c. AIDS-defining malignancies d. AIDS-defining opportunistic infections 10. Which HIV/AIDS-related opportunistic malignancy is more likely to cause death within months of the diagnosis? a. Kaposi s sarcoma b. Non-Hodgkin s lymphoma 11. HIV infects which of the following cells in the central nervous system? a. Macrophages b. Astrocytes c. Neurons 12. Hairy leukoplakia: a. Occurs in early HIV disease b. Is difficult to treat effectively c. Occurs only in late HIV disease d. a. and b. above e. b. and c. above 13. Kaposi s sarcoma: a. Has a variable course b. Cannot be cured c. Usually must be diagnosed by biopsy and histologic examination e. a. and c. above 14. The most common opportunistic infection diagnostic of AIDS is: a. Histoplasmosis b. Toxoplamosis c. Pneumocystis carinii d. Mycobacterium tuberculosis e. Leishmaniasis 2

3 15. Immune reconstitution disease (IRIS): a. Occurs after initiation of HAART b. Is more prevalent among HIV-infected persons with very low levels of CD4 cells c. Both of the above 16. HAART: a. Reduces HIV replication b. Increases or maintains levels of CD4 cells c. Favors less fit mutated HIV strains 17. Which of the following outcomes of HIV infection have increased since the discovery of HAART? a. AIDS malignancies b. Cardiovascular disease c. Hepatitis 18. According to a 2005 study in the United Kingdom, the leading cause of AIDS-related deaths among individuals treated with HAART was: a. Poor adherence to medication (not taking pills) b. Diagnosis too late for effective treatment c. Untreatable complications of HIV infection d. Multiple drug resistance 19. At what level of CD4 cells should HAART be initiated in asymptomatic HIV-infected persons according to current NIH guidelines? a. 750 b. 500 c. 350 d. 200 e The level of adherence to HAART should not be below what level to assure maximum efficacy? a. 55% b. 73% c. 88% d. 95% 21. To maximize the effectiveness of treatment with HAART, the medical team should include: a. Social workers b. Nurses c. Physicians e. b. and c. above 3

4 22. The primary objective of antiretroviral therapy should be: a. Increasing the number of CD4 cells b. Increasing the number of CD8 cells c. Complete suppression of HIV RNA d. Complete suppression of all HIV-related symptoms 23. Innate immunity is stimulated by a foreign antigen: a. Within several hours of exposure b. Within 1-2 weeks of exposure c. Within 2-3 months of exposure d. Only after the cell-mediated response is achieved 24. The innate immune response requires: a. Natural killer (NK) cells b. Granulocytes c. Antigen-presenting cells 25. The skin is part of the host defense mechanism against HIV infection: 26. Which part of the immune system is currently thought to play the most important role in defending against HIV during the asymptomatic stage? a. The cell-mediated immune response b. The antibody response c. The innate immune response d. Physical barriers of the host 27. CD8 cells require cell-to-cell contact in order to recognize and kill HIV-infected cells: 28. Communication between the cells of the immune system is accomplished by: a. Cytokines b. Chemokines c. Both 29. An acquired immune response requires primarily: a. T cells b. B cells c. Macrophages 4

5 30. Which of the following immune cells secrete cytokines? a. CD4 (helper) cells b. CD8 (cytotoxic cells) c. B cells d. Macrophages e. Dendritic cells 31. Which molecule is responsible for antigen presentation and T-cell recognition of an antigen? a. MHC b. NK c. KL d. AP 32. Tolerance involves elimination of self-reactive T or B cells: 33. Cellular immune responses to HIV occur most frequently in: a. Peripheral blood b. Lymph nodes and spleen c. Stomach d. Genital tissue 34. The drop in levels of HIV following infection is primarily due to which of the following components of the immune system? a. CD4 cells b. CD8 cells c. NK cells d. Macrophages e. B cells 35. HIV infection causes: a. A decline in the number of circulating CD4 cells b. An increase in the number of circulating CD8 cells c. Aberrant cytokine production 36. Glycosylation of gp120 inhibits neutralization by antibodies: 37. Neutralization of HIV by the immune system is hindered by: a. The time required to produce neutralizing antibodies b. The rapid rate of mutation of HIV c. Glycosylation of gp120 and gp41 e. b. and c. above 5

6 38. Antigen-presenting cells can be infected by HIV: 39. Activation of a T cell requires: a. CD3 b. CD28 c. CD HIV can infect: a. CD4 cells b. CD8 cells c. Macrophages 41. It is estimated that it will take how long to eliminate all latently infected HIV cells for individuals treated with HAART? a. 12 years b. 43 years c. 60 years d. 73 years e. 8 months 42. Final maturation of HIV doesn t occur until the progeny virus buds from the infected CD4 cell: 43. Naive T cells have not: a. Yet seen their specific antigen b. Have seen but not recognized their specific antigen c. Have become resistant to stimulation by their specific antigen d. Occur only as B cells 44. Thymocytes display both CD4 and CD8 receptors: 45. p24 is the primary antigen for which part of HIV? a. Core b. Envelope c. Enzymes d. Regulatory genes 6

7 46. Which of the following cancers is currently diagnostic of AIDS? a. Kaposi s sarcoma b. Non-Hodgkin s lymphoma c. Cervical cancer 47. Which component of HIV first attaches to the CD4 cell? a. Gag b. Pol c. gp41 d. gp120 e. p HIV can enter cells through endocytosis: 49. HIV incorporates the complete lipid layer of the CD4 cell into the progeny viruses as they bud: 50. CD4 cell production is immediately reduced following infection with HIV: 51. The average interval between time of HIV infection and onset of clinical AIDS in the U.S. is: a. 1-2 years b. 4 years c. 5-7 years d years e years 52. The number of persons living with HIV/AIDS world-wide in 2008 was: a. 11 million b. 21 million c. 33 million d. 55 million 53. What proportion of infected persons are years of age? a. One third b. One quarter c. One half d. Three quarters 7

8 54. The highest proportion of HIV-infected persons in Africa are: a. Injection drug users b. Sexually active heterosexuals c. Men-who-have-sex-with-men d. Hemophiliacs e. Migrants 55. Which global region has the lowest reporting fraction of AIDS cases? a. Africa b. North America c. Western Europe d. Eastern Europe e. Latin America 56. Which risk group accounts for the highest proportion of HIV-infected individuals in the United States? a. Injection drug users b. Men-who-have-sex-with-men c. Sexually active heterosexuals d. Non-injection drug users e. Women-who-have-sex-with-women 57. The group in the United States at the highest risk for HIV infection is: a. European-American men b. Hispanic-American men c. African-American men d. Asian-American men e. European-American women 58. Which type of intercourse has the highest risk of transmitting HIV? a. Receptive vaginal intercourse b. Receptive anal intercourse c. Insertive (male) vaginal intercourse d. Insertive anal intercourse e. Receptive oral intercourse 59. What level of CD4 cells in the presence of HIV antibody is diagnostic of AIDS according to the 1993 U.S. Centers for Disease Control classification? a. 100 b. 200 c. 350 d Pooling is cost-effective for reducing costs of testing when the prevalence of HIV is: a. Very high b. High c. Moderate d. Low 8

9 61. The opt out strategy of HIV testing allows the individual to avoid testing unless they specifically request to be tested: 62. The U.S. Centers for Disease Control now recommends which strategy for HIV testing? a. Opt out b. Opt in 63. Stigma regarding HIV testing can be reduced by using the opt out strategy: 64. Which of the two forms of HIV below is infectious? a. b. 9

5. Over the last ten years, the proportion of HIV-infected persons who are women has: a. Increased b. Decreased c. Remained about the same 1

5. Over the last ten years, the proportion of HIV-infected persons who are women has: a. Increased b. Decreased c. Remained about the same 1 Epidemiology 227 April 24, 2009 MID-TERM EXAMINATION Select the best answer for the multiple choice questions. There are 60 questions and 9 pages on the examination. Each question will count one point.