Question 1:
A 35-year-old male with HIV (CD4 count 180 cells/μL) presents with shortness of breath and a dry cough. Chest X-ray shows bilateral interstitial infiltrates. What is the most likely diagnosis?

A) Bacterial pneumonia
B) Tuberculosis
C) Pneumocystis jirovecii pneumonia (PCP)
D) Kaposi’s sarcoma
E) Lymphocytic interstitial pneumonia

Question 2:
Which of the following opportunistic infections is most common in HIV-positive patients with a CD4 count below 200 cells/μL and presents with respiratory symptoms?

A) Mycobacterium avium complex
B) Cytomegalovirus
C) Pneumocystis jirovecii pneumonia
D) Toxoplasmosis
E) Cryptococcosis

Question 3:
In HIV-infected patients, which pulmonary complication is characterized by the formation of multiple, bilateral nodular lesions that can cavitate?

A) Bacterial pneumonia
B) Tuberculosis
C) Kaposi’s sarcoma
D) Non-tuberculous mycobacterial infection
E) Lymphoma

Question 4:
A 40-year-old female with HIV (CD4 count 350 cells/μL) develops a cough, fever, and wheezing. Chest X-ray reveals patchy infiltrates. What is the most likely cause?

A) Pneumocystis jirovecii pneumonia
B) Bacterial pneumonia
C) Pulmonary Kaposi’s sarcoma
D) Allergic bronchopulmonary aspergillosis
E) Tuberculosis

Question 5:
Which of the following is the recommended prophylaxis against Pneumocystis jirovecii pneumonia in HIV patients with CD4 counts below 200 cells/μL?

A) Azithromycin
B) Amphotericin B
C) Trimethoprim-sulfamethoxazole
D) Isoniazid
E) Fluconazole

Question 6:
An HIV-positive patient presents with a chronic cough and weight loss. Sputum smear is positive for acid-fast bacilli. What is the most likely diagnosis?

A) Bacterial pneumonia
B) Pneumocystis jirovecii pneumonia
C) Tuberculosis
D) Non-tuberculous mycobacterial infection
E) Lung cancer

Question 7:
Which lung cancer type is more common in HIV-infected individuals, even with high CD4 counts?

A) Small cell lung cancer
B) Adenocarcinoma
C) Squamous cell carcinoma
D) Kaposi’s sarcoma
E) Lymphoma

Question 8:
In HIV-infected patients, which diagnostic test is most accurate for diagnosing Pneumocystis jirovecii pneumonia?

A) Chest X-ray
B) Sputum culture
C) Bronchoalveolar lavage
D) Serology
E) Tuberculin skin test

Question 9:
A 50-year-old male with HIV presents with fever, cough, and pleuritic chest pain. Chest CT shows a pleural-based mass. Biopsy reveals mesothelial cells. What is the most likely diagnosis?

A) Pleural tuberculosis
B) Mesothelioma
C) Bacterial empyema
D) Pulmonary Kaposi’s sarcoma
E) Lung abscess

Question 10:
Which of the following is a common side effect of antiretroviral therapy (ART) that can impact lung function?

A) Pulmonary fibrosis
B) Bronchiectasis
C) Pneumothorax
D) Drug-induced pneumonitis
E) Emphysema

Question 11:
An HIV-positive patient presents with hemoptysis and a CD4 count of 250 cells/μL. Chest X-ray reveals cavitary lesions in the upper lobes. What is the most likely diagnosis?

A) Tuberculosis
B) Pneumocystis jirovecii pneumonia
C) Kaposi’s sarcoma
D) Lung cancer
E) Non-tuberculous mycobacterial infection

Question 12:
Which of the following organisms is most commonly associated with chronic lung disease in HIV-infected patients?

A) Staphylococcus aureus
B) Pseudomonas aeruginosa
C) Streptococcus pneumoniae
D) Haemophilus influenzae
E) Moraxella catarrhalis

Question 13:
A 45-year-old male with HIV presents with a persistent dry cough and CD4 count of 500 cells/μL. High-resolution CT shows mediastinal lymphadenopathy and interstitial lung disease. What is the most likely diagnosis?

A) Lymphocytic interstitial pneumonia
B) Sarcoidosis
C) Pulmonary hypertension
D) Lymphoma
E) Pulmonary Kaposi’s sarcoma

Question 14:
In an HIV-infected patient, which of the following findings on chest X-ray would raise suspicion for lymphocytic interstitial pneumonia?

A) Bilateral pleural effusions
B) Diffuse nodular opacities
C) Hilar lymphadenopathy
D) Upper lobe cavitary lesions
E) Ground-glass opacities

Question 15:
Which of the following is the most appropriate initial treatment for an HIV-positive patient with confirmed active tuberculosis?

A) Standard four-drug regimen (isoniazid, rifampin, pyrazinamide, ethambutol)
B) Amphotericin B
C) Trimethoprim-sulfamethoxazole
D) Antiretroviral therapy alone
E) Corticosteroids

Question 16:
A 30-year-old female with HIV presents with dyspnea and a CD4 count of 400 cells/μL. Echocardiogram shows pulmonary hypertension. What is the most likely etiology?

A) Left heart disease
B) Chronic thromboembolic disease
C) HIV-associated pulmonary arterial hypertension
D) Lung parenchymal disease
E) Chronic liver disease

Question 17:
In HIV-infected patients, which pulmonary infection is characterized by rapidly progressive cavitary lesions in the upper lobes and requires immediate treatment?

A) Bacterial pneumonia
B) Tuberculosis
C) Pneumocystis jirovecii pneumonia
D) Non-tuberculous mycobacterial infection
E) Invasive aspergillosis

Question 18:
A 55-year-old male with advanced HIV infection presents with respiratory failure. He has a CD4 count of 100 cells/μL and is not on antiretroviral therapy. Chest X-ray shows diffuse infiltrates. Which diagnosis should be considered first?

A) Bacterial pneumonia
B) Tuberculosis
C) Pneumocystis jirovecii pneumonia
D) Pulmonary Kaposi’s sarcoma
E) Cryptococcal pneumonia

Question 19:
Which antiretroviral drug class is associated with an increased risk of bronchial hyperreactivity and respiratory symptoms?

A) Nucleoside reverse transcriptase inhibitors
B) Non-nucleoside reverse transcriptase inhibitors
C) Protease inhibitors
D) Integrase inhibitors
E) Entry inhibitors

Question 20:
A 40-year-old male with HIV and a history of smoking presents with a persistent cough and hemoptysis. Chest CT shows a solitary pulmonary nodule. What is the most important next step in management?

A) Start antiretroviral therapy
B) CT-guided biopsy
C) Start empirical antibiotics
D) Tuberculin skin test
E) Sputum culture for acid-fast bacilli

Answers and explanations

Question 1:
Correct Answer: C) Pneumocystis jirovecii pneumonia (PCP)
Explanation: In an HIV-positive patient with a low CD4 count presenting with bilateral interstitial infiltrates, PCP is the most likely diagnosis.
Teaching Point: PCP is a common opportunistic infection in HIV-positive patients with CD4 counts below 200 cells/μL, presenting with respiratory symptoms and bilateral interstitial infiltrates.

Question 2:
Correct Answer: C) Pneumocystis jirovecii pneumonia
Explanation: PCP is a frequent opportunistic infection in HIV-positive patients with CD4 counts below 200 cells/μL and typically presents with respiratory symptoms such as cough and dyspnea.
Teaching Point: Prophylaxis with trimethoprim-sulfamethoxazole is recommended in HIV patients with CD4 counts below 200 cells/μL to prevent PCP.

Question 3:
Correct Answer: C) Kaposi’s sarcoma
Explanation: In HIV-infected patients, Kaposi’s sarcoma can present with multiple bilateral nodular lesions that may cavitate, especially in those with advanced disease.
Teaching Point: Kaposi’s sarcoma should be considered in HIV patients with respiratory symptoms and nodular lung lesions, even with high CD4 counts.

Question 4:
Correct Answer: B) Bacterial pneumonia
Explanation: In HIV-infected patients, even with relatively preserved CD4 counts, bacterial pneumonia is common and can present with cough, fever, wheezing, and patchy infiltrates.
Teaching Point: Bacterial pneumonia remains a significant cause of morbidity in HIV-positive patients, regardless of their CD4 count.

Question 5:
Correct Answer: C) Trimethoprim-sulfamethoxazole
Explanation: Trimethoprim-sulfamethoxazole is the recommended prophylaxis against PCP in HIV patients with CD4 counts below 200 cells/μL.
Teaching Point: Prophylactic use of trimethoprim-sulfamethoxazole in patients with low CD4 counts significantly reduces the risk of PCP, a potentially life-threatening infection.

Question 6:
Correct Answer: C) Tuberculosis
Explanation: The presence of acid-fast bacilli in sputum smear in an HIV-positive patient with chronic cough and weight loss strongly suggests tuberculosis.
Teaching Point: Tuberculosis is common in HIV-infected individuals and can present with typical symptoms such as cough, weight loss, and night sweats.

Question 7:
Correct Answer: B) Adenocarcinoma
Explanation: Adenocarcinoma is more common in HIV-infected individuals, even those with high CD4 counts, compared to other lung cancer types.
Teaching Point: Lung cancer, particularly adenocarcinoma, has a higher incidence in HIV-positive individuals, underscoring the importance of cancer surveillance in this population.

Question 8:
Correct Answer: C) Bronchoalveolar lavage
Explanation: Bronchoalveolar lavage (BAL) is the most accurate diagnostic test for PCP, allowing for direct sampling of the lower respiratory tract.
Teaching Point: BAL is often performed in suspected cases of PCP when less invasive methods are inconclusive, especially in HIV-positive patients.

Question 9:
Correct Answer: A) Pleural tuberculosis
Explanation: The presence of a pleural-based mass in an HIV-positive patient with respiratory symptoms raises the suspicion of pleural tuberculosis, especially in the context of endemic areas or risk factors.
Teaching Point: Pleural involvement in tuberculosis can present with mass-like lesions, effusions, or thickening, and should be considered in HIV patients with pleural abnormalities.

Question 10:
Correct Answer: D) Drug-induced pneumonitis
Explanation: Certain antiretroviral drugs, particularly some protease inhibitors and nucleoside reverse transcriptase inhibitors, have been associated with drug-induced pneumonitis.
Teaching Point: Monitoring for respiratory side effects is important in patients on antiretroviral therapy, as some drugs can cause lung injury or exacerbate underlying lung conditions.

Question 11:
Correct Answer: A) Tuberculosis
Explanation: In an HIV-positive patient with hemoptysis and cavitary lesions in the upper lobes, tuberculosis is a likely diagnosis, particularly in areas where TB is prevalent.
Teaching Point: Tuberculosis should be a primary consideration in HIV-positive patients presenting with cavitary lung lesions, and prompt diagnostic testing should be pursued.

Question 12:
Correct Answer: C) Streptococcus pneumoniae
Explanation: Streptococcus pneumoniae is a common cause of chronic lung disease and recurrent pneumonia in HIV-infected patients, regardless of CD4 count.
Teaching Point: HIV patients are at increased risk for bacterial infections like pneumococcal pneumonia, highlighting the need for vaccination and vigilant monitoring for respiratory symptoms.

Question 13:
Correct Answer: A) Lymphocytic interstitial pneumonia
Explanation: In an HIV-positive patient with a CD4 count above 200 cells/μL, presenting with dry cough and interstitial lung disease, lymphocytic interstitial pneumonia should be considered.
Teaching Point: Lymphocytic interstitial pneumonia is a rare but recognized complication in HIV patients, characterized by interstitial infiltrates and lymphadenopathy.

Question 14:
Correct Answer: B) Diffuse nodular opacities
Explanation: Lymphocytic interstitial pneumonia in HIV-infected patients often presents on chest X-ray with diffuse nodular opacities.
Teaching Point: Lymphocytic interstitial pneumonia should be considered in HIV-positive patients with diffuse nodular opacities, especially those with a higher CD4 count.

Question 15:
Correct Answer: A) Standard four-drug regimen (isoniazid, rifampin, pyrazinamide, ethambutol)
Explanation: The standard four-drug regimen is the most appropriate initial treatment for active tuberculosis in HIV-positive patients, regardless of CD4 count.
Teaching Point: Active tuberculosis in HIV-infected patients should be treated promptly with standard first-line anti-tubercular drugs, and antiretroviral therapy should be integrated into their care.

Question 16:
Correct Answer: C) HIV-associated pulmonary arterial hypertension
Explanation: HIV-associated pulmonary arterial hypertension is a recognized complication and should be considered in HIV patients with dyspnea and evidence of pulmonary hypertension on echocardiogram.
Teaching Point: Pulmonary arterial hypertension in HIV patients requires comprehensive management, including potential antiretroviral therapy and specific treatment for pulmonary hypertension.

Question 17:
Correct Answer: B) Tuberculosis
Explanation: Rapidly progressive cavitary lesions in the upper lobes in an HIV-infected patient are suggestive of tuberculosis, requiring immediate investigation and treatment.
Teaching Point: Tuberculosis can present aggressively in HIV-positive patients, particularly those with advanced immunosuppression, and should be treated urgently.

Question 18:
Correct Answer: C) Pneumocystis jirovecii pneumonia
Explanation: In an HIV-positive patient with advanced disease and respiratory failure, PCP is a common and potentially life-threatening diagnosis, especially in those not on antiretroviral therapy.
Teaching Point: PCP is a leading cause of respiratory failure in HIV patients with low CD4 counts and requires high clinical suspicion and prompt treatment.

Question 19:
Correct Answer: C) Protease inhibitors
Explanation: Protease inhibitors, a class of antiretroviral drugs, have been associated with bronchial hyperreactivity and respiratory symptoms such as cough and wheezing.
Teaching Point: Monitoring for respiratory side effects is important in patients on protease inhibitors, as these drugs can exacerbate underlying lung diseases or cause new respiratory symptoms.

Question 20:
Correct Answer: B) CT-guided biopsy
Explanation: In an HIV-positive patient with a solitary pulmonary nodule and a history of smoking, a CT-guided biopsy is important to rule out malignancies, including lung cancer or infections like tuberculosis.
Teaching Point: Solitary pulmonary nodules in HIV-positive patients, particularly smokers, warrant thorough investigation to differentiate between infectious, inflammatory, and neoplastic causes.