Gen I To Urinary

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A 67-year-old male presents after having a urine tract infection treated and has read in a magazine that maybe
Test Analysis
it would be worth checking a PSA.

When should his PSA be checked?
(Please select 1 option)
Check in three days
Check in one week
Check in two weeks
Check on this occasion
No need to check PSA
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A 67-year-old male presents after having a urine tract infection treated and has read in a magazine that maybe
Answer Statistics
it would be worth checking a PSA.

When should his PSA be checked?
Test Analysis

Check in three days
Incorrect answer selected
Check in one week

Check in two weeks
This is the correct answer
Check on this occasion

No need to check PSA
PSA concentrations can rise with problems of false positives after catheterisation and particularly urine tract
infections.
Therefore, if one has decided to check a PSA then it is recommended that this should be measured at least
two weeks after a treated UTI.
Score:
Please bear in mind that this is a controversial area and one where the guidelines are not completely clear.
Total Answered:
You would expect some prostatic symptoms in patients with prostatic carcinoma, but most of these will actually
have BPH rather than carcinoma. Many men will come requesting a PSA and it can be useful in those patients
with a family history, young age etc.
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In practice it would probably be worth checking it in a male presenting with a UTI, as such a diagnosis is fairly
rare in this age group. It is important to allow the infection to clear first however, to reduce the risk of a false
positive result.
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A 56-year-old man who has presented with chest pain, has a PSA of 45 ng/ml (normal less than 4).
Test Analysis
Which of the following statements is correct with respect to this patient's management?
An elevated PSA is a definitive test for prostate cancer
High selenium intake is related to prostate cancer
Prostate cancer is more aggressive with increasing age
Prostate cancer is typically squamous call carcinoma
The most commonly used pathological grading system is the Gleason score
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A 56-year-old man who has presented with chest pain, has a PSA of 45 ng/ml (normal less than 4).
Answer Statistics
Which of the following statements is correct with respect to this patient's management?
Test Analysis

An elevated PSA is a definitive test for prostate cancer
High selenium intake is related to prostate cancer

Prostate cancer is more aggressive with increasing age
Prostate cancer is typically squamous call carcinoma
The most commonly used pathological grading system is the Gleason score
Prostate-specific antigen (PSA) may be elevated in prostatitis, benign prostatic hyperplasia and prostate
cancer.
High intake of animal fats is related to prostate cancer, as well as low intake of selenium.
As a rule, prostate cancer is more aggressive in younger men.
Score:
Prostate cancer is an adenocarcinoma.
Total Answered:
The Gleason score is recommended by the American College of Pathologists. The most well differentiated
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tumours have a Gleason score of 2, and the most poorly differentiated a Gleason score of 10.
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A 46-year-old homosexual HIV positive man presents with a two week history of weakness of his right arm and
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leg.
Examination reveals right hemiparesis and left cerebellar signs. CT scan shows white matter lesions in the left
cerebellar region and left temporoparietal area. There is no midline shift or surrounding oedema.
Test Analysis
Which one of the following is most likely to be found in his cerebrospinal fluid (CSF)?
Positive cytomegalovirus (CMV) PCR
Positive Epstein-Barr virus (EBV) PCR

Positive herpes simplex virus (HSV) PCR
Positive human herpes virus (HHV) 8 PCR
Positive JC PCR
Multifocal lesions in left cerebellar and temporoparietal white matter areas without any mass effect or
surrounding oedema are most likely to be due to progressive multifocal leucoencephalopathy (PML).
Score:
JC virus causes PML in immunocompromised patients especially when the CD4 count is below 100 cells/mm 3 .
Total Answered:
CMV polymerase chain reaction (PCR) may be found in CMV encephalitis. It is clinically not a typical feature of
CMV encephalitis.
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Positive EBV PCR indicates primary brain lymphoma where CT scan often shows significant mass effect with
surrounding oedema.
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HSV PCR may be found in HSV encephalitis which commonly affects temporal lobes in patients with good CD4
count.
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HHV 8 PCR is usually associated with Kaposi's sarcoma.
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A 39-year-old Caucasian man with symptomatic HIV disease developed multiple painless umbilicated papular
Test Analysis
lesions on his face.

What is the most likely cause of his skin lesions?
Cytomegalovirus (CMV)
Epstein Barr virus (EBV)
Human herpes virus (HHV) 8
Human papilloma virus (HPV 16)
Pox virus
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A 39-year-old Caucasian man with symptomatic HIV disease developed multiple painless umbilicated papular
Answer Statistics
lesions on his face.

What is the most likely cause of his skin lesions?
Test Analysis

Epstein Barr virus (EBV)

Human herpes virus (HHV) 8
Human papilloma virus (HPV 16)
Pox virus
Multiple painless umbilicated papular lesions are typical of molluscum contagiosum and are caused by pox
virus.
CMV does not cause painless papular lesions.
Score:
EBV causes Burkitt's lymphoma, non-Hodgkin's lymphoma and primary brain lymphomas.
Total Answered:
HHV 8 is strongly associated with Kaposi's sarcoma.
HPV 16 is associated with squamous cell carcinomas in cervix, penis, anus and oral cavity.
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Reference:
Rate this question
Ban S, Yoganathan K. Physical signs for the general dental practitioner. Case 51. Molluscum contagiosum.
Dent Update. 2008;35(1):68.
Yoganathan K, et al. Carcinoma of the penis in a HIV positive patient. Genitourin Med. 1995;71(1):41-2.
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A 35-year-old HIV positive African woman presented with weakness of both legs and double incontinence.
Test Analysis
CSF showed increased protein and neutrophils with normal glucose.

What is the most likely cause of her weakness?
CMV polyradiculomyelopathy
Guillain-Barr syndrome
Herpes virus encephalitis
HIV encephalopathy
Toxoplasma encephalitis
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A 35-year-old HIV positive African woman presented with weakness of both legs and double incontinence.
Answer Statistics
CSF showed increased protein and neutrophils with normal glucose.

Test Analysis

CMV polyradiculomyelopathy
Correct
Guillain-Barr syndrome
Herpes virus encephalitis
HIV encephalopathy
Toxoplasma encephalitis
Symptoms are suggestive of polyradiculomyelopathy (weakness of legs with involvement of sphincters).

Increased neutrophils are found in CMV polyradiculomyelopathy but not in Guillain-Barr syndrome.
HIV encephalopathy usually causes confusion and memory loss. It does not involve sphincters.
Score:
Guillain-Barr syndrome causes polyradiculopathy, explaining all her symptoms, but with normal cell counts
Total Answered:
and raised protein in the CSF.

Herpes simplex encephalitis causes fever, headache, confusion and deteriorating level of consciousness.
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A 51-year-old homosexual Caucasian HIV positive man developed multiple violaceous painless lesions on his
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trunk.
Which one of the following is the most likely cause of his skin lesions?
Human herpes virus 8 (HHV8)
Human herpes virus 10 (HHV 10)
Human papilloma virus 16 (HPV 16)
Pox virus
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A 51-year-old homosexual Caucasian HIV positive man developed multiple violaceous painless lesions on his
Answer Statistics
trunk.
Which one of the following is the most likely cause of his skin lesions?
Test Analysis

Human herpes virus 8 (HHV8)
Human herpes virus 10 (HHV 10)

Pox virus
Multiple violaceous painless lesions are typical of Kaposi's sarcoma in Caucasians. This is associated with
HHV 8.
CMV and HHV 10 do not cause multiple violaceous painless lesions.
Score:
HPV 16 is an oncogenic virus which causes squamous cell carcinomas.
Total Answered:
Pox virus causes molluscum contagiosum.
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A 32-year-old African woman with HIV presents with a two week history of greenish, frothy, itchy vaginal
Test Analysis
discharge.
What is the most likely cause of her discharge?
Candida albicans infection
Chlamydia infection
Foreign body
Gonorrhoea infection
Trichomonas vaginalis infection
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A 32-year-old African woman with HIV presents with a two week history of greenish, frothy, itchy vaginal
Answer Statistics
discharge.
What is the most likely cause of her discharge?
Test Analysis

Candida albicans infection
Chlamydia infection
Foreign body
Gonorrhoea infection
Trichomonas vaginalis infection
Trichomonas vaginalis causes itchy, frothy, greenish vaginal discharge.

Candida albicans causes a white, curdy, itchy vaginal discharge.
Chlamydia and gonorrhoea do not cause itchy, frothy vaginal discharge and both can be asymptomatic.
Foreign body causes foul smelling vaginal discharge.
Score:
Total Answered:
Further Reading:
British Association of Sexual Health and HIV (BASHH). United Kingdom National Guideline on the Management
of Trichomonas vaginalis (2007).
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Which of the following is a sign of immunodeficiency in the mouth?
Test Analysis

Gingivitis
Herpes labialis
Leucoplakia
Oral hairy leucoplakia
Oral wart
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Which of the following is a sign of immunodeficiency in the mouth?
Answer Statistics

Gingivitis
Test Analysis
Herpes labialis
Leucoplakia
Oral hairy leucoplakia
Oral wart
Oral hairy leucoplakia is a sign of immunodefiency. It is due to reactivation of Epstein-Barr virus infection.
Gingivitis is not a sign of immunodefiency.
Leucoplakia is not a sign of immunodefiency but it is a precancerous lesion.
Herpes labialis is due to herpes simplex infection, which causes 'cold sores' in immunocompetent patients and
chronic herpes labialis in immunocompromised patients.
Score:
Oral warts can occur in healthy people. They are due to HPV infection usually due to benign types, 6 and 11.
Total Answered:
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Which one of the following antiretrovirals is likely to cause increased pigmentation of the skin in a black African
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patient?
Didanosine
Efavirenz
Emtricitabine
Nevirapine
Stavudine
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Which one of the following antiretrovirals is likely to cause increased pigmentation of the skin in a black African
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patient?
Didanosine
Test Analysis
Efavirenz
Emtricitabine
Nevirapine
Stavudine
Emtricitabine causes hyperpigmentation of skin including palmar creases in 8% of black patients.

Didanosine and stavudine cause mitochondrial toxicity, hence peripheral neuropathy, pancreatitis and
hyperlactataemia.
Efavirenz causes CNS toxicity.
Score:
Nevirapine causes acute hepatitis and skin rash.
Total Answered:
Reference:
Rashbaum B. Evaluation of Hyperpigmentation in HIV-Infected Pateients Receiving Emtricitabine. 3rd IAS
Conference on HIV Pathogenesis and Treatment 2005:TuPe2.4C15
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A 34-year-old homosexual Caucasian man developed jaundice two months after taking a combination of
Test Analysis
antiretroviral drugs.
He admitted that he had had several episodes of unprotected sex with several casual male partners. His liver
function showed raised bilirubin with normal transaminases and alkaline phosphatase.
What is the most likely cause of his jaundice?
Acute hepatitis B
Alcoholic hepatitis
Atazanavir
Efavirenz
Nevirapine
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A 34-year-old homosexual Caucasian man developed jaundice two months after taking a combination of
Answer Statistics
antiretroviral drugs.
He admitted that he had had several episodes of unprotected sex with several casual male partners. His liver
function showed raised bilirubin with normal transaminases and alkaline phosphatase.
Test Analysis
What is the most likely cause of his jaundice?

Acute hepatitis B
Alcoholic hepatitis
Atazanavir
Efavirenz
Nevirapine
Atazanavir causes hyperbilirubinaemia with normal transaminases and alkaline phosphatase (mimicking
Gilbert's syndrome).
Score:
Acute hepatitis B is unlikely with normal trasaminases and alkaline phosphatase.
Total Answered:
A mild to moderate rise in trasaminases and alkaline phosphatase occurs in alcoholic hepatitis.
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Efavirenz can cause acute hepatitis with raised levels of transaminases.
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Nevirapine causes acute hepatitis where transaminases are raised several-fold.

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A 47-year-old Portuguese former intravenous drug abuser presented with a two week history of right
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hemiparesis.
He was found to have hepatitis B and C infection. His absolute lymphocyte count was 0.6 109/L. CT of the
head showed multiple ring-enhanced lesions.
What would be your next best course of action?
Manage him conservatively with physiotherapy
Refer him to a neurosurgeon for urgent brain biopsy
Refer him to a stroke specialist
Request an HIV antibody test
Start thrombolysis treatment
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A 47-year-old Portuguese former intravenous drug abuser presented with a two week history of right
Answer Statistics
hemiparesis.
He was found to have hepatitis B and C infection. His absolute lymphocyte count was 0.6 109/L. CT of the
head showed multiple ring-enhanced lesions.
Test Analysis
What would be your next best course of action?

Manage him conservatively with physiotherapy
Refer him to a neurosurgeon for urgent brain biopsy

Refer him to a stroke specialist
Request an HIV antibody test
Start thrombolysis treatment
This man was already infected with two blood-borne viruses (hepatitis B and C). His absolute lymphocyte count
was low. CT scan showed multiple ring-enhanced lesions, which were suggestive of cerebral toxoplasmosis.
Score:
Therefore, testing HIV is the next best course of action. Finding multiple ring-enhanced lesions on CT scan
needs further investigations.
Total Answered:
Managing conservatively with physiotherapy is not an appropriate course of action.
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CT scan is not typical of brain tumour, hence referring him for urgent brain biopsy is not the best course of
action.
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Thrombolysis treatment should not be started, as the CT scan was not typical of ischaemic stroke.
Reference:
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Yoganathan K. A 'brain tumor' in an intravenous drug abuser. Int J Gen Med. 2009;2:73-5.
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A 34-year-old Thai lady presented with a left hemiparesis of two weeks duration.
Test Analysis
HIV antibody test was positive. CT scan of the head showed multiple ring-enhanced lesions.
Amoebic brain abscesses
Cerebral toxoplasmosis
Herpes simplex encephalitis
Primary brain lymphoma
Progressive multifocal leucoencephalopathy
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A 34-year-old Thai lady presented with a left hemiparesis of two weeks duration.
Answer Statistics
HIV antibody test was positive. CT scan of the head showed multiple ring-enhanced lesions.
Test Analysis

Amoebic brain abscesses
Cerebral toxoplasmosis

Herpes simplex encephalitis

Primary brain lymphoma
Progressive multifocal leucoencephalopathy
Cerebral toxoplasmosis is the most likely diagnosis. Multiple ring-enhanced lesions are commonly seen in
patients with cerebral toxoplasmosis, though solitary ring enhanced lesions are seen in 25% of patients on CT
scan. MRI scan is more sensitive in identifying small lesions than CT scan.
Score:
Amoebic brain abscesses are not the most likely cause in this patient.
Total Answered:
Multiple ring-enhanced lesions are not seen in patients with herpes simplex encephalitis.
Primary brain lymphoma causes a significant mass effect with surrounding oedema.
Feedback
Progressive multifocal leucoencephalopathy causes multifocal white matter lesions without any mass effect or
surrounding oedema.
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Reference:
Yoganathan K. A 'brain tumor' in an intravenous drug abuser. Int J Gen Med. 2009;2:73-5.
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Which one of the following is an oncogenic virus?
Test Analysis

Hepatitis A
Varicella zoster virus (VZV)
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Which one of the following is an oncogenic virus?
Answer Statistics

Hepatitis A
Test Analysis

Varicella zoster virus (VZV)
HPV 16 is oncogenic and causes squamous cell carcinomas in the oral cavity, cervix, anus and penis.
Hepatitis A is not an oncogenic virus, as it does not cause chronic infection or cancer.
HPV 6 and 11 typically cause the majority of benign warts.
VZV causes chicken pox and herpes zoster.
Score:
References:
1. British Association for Sexual Health and HIV (BASHH). United Kingdom National Guideline on the
Management of Anogenital Warts, 2007.
2. Yoganathan K, et al. Carcinoma of the penis in a HIV positive patient. Genitourin Med. 1995;71(1):41-2.
Total Answered:
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A 28-year-old man with HIV presents with a five day history of feeling unwell. He is a heavy smoker.
Test Analysis
A chest radiograph showed right upper lobe consolidation. His CD4 count was 468 cells/mm 3. HIV RNA level
was 90,678 copies/ml. He is not on any antiretroviral treatment.
What is the most likely diagnosis?
Bronchial carcinoma
Invasive pulmonary aspergillosis
Pulmonary tuberculosis
Pneumocystis jiroveci pneumonia (PCP)
Streptococcal pneumonia
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A 28-year-old man with HIV presents with a five day history of feeling unwell. He is a heavy smoker.
Answer Statistics
A chest radiograph showed right upper lobe consolidation. His CD4 count was 468 cells/mm 3. HIV RNA level
was 90,678 copies/ml. He is not on any antiretroviral treatment.
Test Analysis
What is the most likely diagnosis?

Bronchial carcinoma
Invasive pulmonary aspergillosis

Pulmonary tuberculosis
Pneumocystis jiroveci pneumonia (PCP)
Streptococcal pneumonia
This is typical of community-acquired pneumonia. One should think of common infections rather than any
opportunistic infections in HIV patients with good CD4 counts. (More than 400 cells/mm 3 is not
immunocompromised.)
Score:
It is not a typical history for bronchial carcinoma as the history was short and radiographic changes were not
typical of bronchial carcinoma.
Total Answered:
Invasive pulmonary aspergillosis is unlikely in a patient with good CD4 count. Pulmonary tuberculosis typically
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causes cavitating lesions in a patient with a good CD4 count.
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PCP commonly occurs in patients with CD4 count of less than 200 cells/mm 3 and chest radiograph shows
bilateral infiltrates from the hila without any effusion or lymphadenopathy.
The history is too short for tuberculosis, and apart from HIV there aren't any other risk factors for this.
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A 31-year-old African man presented with a history of fever, night sweats, shortness of breath and weight loss
Test Analysis
for two months.

His chest radiograph showed a moderately severe left pleural effusion only. He consented to an HIV test which
was positive.
What is the most likely cause of pleural effusion?
Hodgkin's lymphoma
Pleural tuberculosis
Pneumocystis jirovecii pneumonia (PCP)
Pulmonary aspergillosis
Pulmonary Kaposi's sarcoma
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A 31-year-old African man presented with a history of fever, night sweats, shortness of breath and weight loss
Answer Statistics
for two months.

His chest radiograph showed a moderately severe left pleural effusion only. He consented to an HIV test which
was positive.
Test Analysis
What is the most likely cause of pleural effusion?

Hodgkin's lymphoma
Pleural tuberculosis

Pneumocystis jirovecii pneumonia (PCP)

Pulmonary aspergillosis
Pulmonary Kaposi's sarcoma
Pleural tuberculosis is the most likely cause in an HIV positive African man with a two month history of weight
loss. His pleural effusion is due to pleural tuberculosis (extra pulmonary tuberculosis).
Hodgkin's lymphoma can cause pleural effusion due to pleural involvement but it is often associated with
mediastinal mass. His chest radiographshowed only pleural effusion. Non-Hodgkin's lymphoma (not Hodgkin's
lymphoma) is commonly associated with these patients.
PCP does not cause pleural effusion. It typically causes bilateral reticular shadows from the hila without any
hilar lymph node enlargement or pleural effusion.
Pulmonary aspergillosis shows infiltrative lesions but it does not typically cause pleural effusion.
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Pulmonary Kaposi's sarcoma can cause pleural effusion by involving the pleura, but it often causes coarse
irregular nodular lesions in the lungs.
Reference:
el-Gadi SM, et al. Kaposi sarcoma presenting as severe haemoptysis. Genitourin Med. 1997;73(6):575-6.
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Which one of the following is an AIDS defining illness?
Test Analysis

Anal canal warts
Extra genital molluscum contagiosum
Multidermatomal shingles
Oesophageal candidiasis
Oral candidiasis
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Which one of the following is an AIDS defining illness?
Answer Statistics

Anal canal warts
Test Analysis
Extra genital molluscum contagiosum

Multidermatomal shingles
Oesophageal candidiasis
Oral candidiasis
Any opportunistic infections or opportunistic malignancies are AIDS defining illnesses.

Oesophageal candidiasis is an AIDS defining illness but oral candidiasis is not.
Anal warts are not an opportunistic infection.
Extra genital molluscum contagiosum is also not an opportunistic infection but frequently occurs in symptomatic
HIV positive patients.
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Multidermatomal shingles is not an opportunistic infection but if it occurs in a young person HIV infection needs
to be excluded.
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Which one of the following cutaneous lesions is associated with HIV infection?
Test Analysis

Leucoplakia
Lichen planus
Lichen sclerosus
Plasma cell balanitis
Psoriasis
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Which one of the following cutaneous lesions is associated with HIV infection?
Answer Statistics

Leucoplakia
Test Analysis
Lichen planus
Lichen sclerosus
Plasma cell balanitis
Psoriasis
It occurs in 2-4% of healthy people. If pre-existing psoriasis flares up for no apparent reason or middle-aged
people develop psoriasis for the first time, one should exclude underlying HIV infection in those patients.
Leucoplakia is a pre-cancerous lesion whereas oral hairy leucoplakia is a sign of immunodefiency in an HIV
positive patient.
Lichen planus, lichen sclerosus and plasma cell balanitis are not associated with HIV infection.
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A 36-year-old Caucasian woman was successfully treated for Pneumocystis jirovecii pneumonia (PCP).
Test Analysis
She was re-admitted with acute breathlessness with left-sided chest pain ten days after her discharge from the
hospital. Examination revealed that she was hypoxic and found to have diminished breath sounds on the left
side of chest.
What is the most likely cause of her recent admission?
Acute myocardial infarction
Acute pericarditis
Acute pulmonary embolism
Left lobar pneumonia
Pneumothorax
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A 36-year-old Caucasian woman was successfully treated for Pneumocystis jirovecii pneumonia (PCP).
She was re-admitted with acute breathlessness with left-sided chest pain ten days after her discharge from the
hospital. Examination revealed that she was hypoxic and found to have diminished breath sounds on the left
side of chest.
Answer Statistics
Test Analysis
What is the most likely cause of her recent admission?

Acute myocardial infarction
Acute pericarditis
Acute pulmonary embolism
Left lobar pneumonia
Pneumothorax
Pneumothorax is a well-known complication of PCP. An acute history of chest pain with breathlessness and
diminished breath sounds is typical of pneumothorax.
Score:
Diminished breath sounds are not a feature of acute myocardial infarction or acute pericarditis.
Total Answered:
Acute pulmonary embolism should be considered due to her recent admission but diminished breath sounds
are not a feature.
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There are no signs of consolidation to consider lobar pneumonia.
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Which one of the following drugs is associated with hypersensitivity reactions?
Test Analysis

Atazanavir
Lamivudine
Nevirapine
Tenofovir
Zidovudine
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Which one of the following drugs is associated with hypersensitivity reactions?
Answer Statistics

Atazanavir
Test Analysis
Lamivudine
Nevirapine
Tenofovir
Zidovudine
Nevirapine can cause acute hepatitis and skin rash as a part of hypersensitive reaction especially when the
CD4 count is over 250 cells/ml in women and over 400 cells/ml in men. Nevirapine should not be prescribed in
those conditions.
Atazanavir causes hyperbilirubinaemia and rarely renal stones.
Lamivudine does not cause hypersensitivity reaction.
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Tenofovir causes proximal tubular damage.
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Zidovudine causes bone marrow suppression.
Reference:
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Danino S, et al. Urolithiasis in an HIV infected patient - a link with atazanavir? HIV Med 2007;8(Suppl 1):45.
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