Block 10 Antiretroviral Transplant Immunology
Tumor progession
Questions and Answers
- 1.
A 37-year-old HIV0-positive homosexual man presented to the immunodeficiency clinic for a follow up visit. His CD4 lymphocyte count was found 300 cells/mcL. An HAART (Highly Active Antiretroviral Therapy) was initiated. Which of the following triple drug regimen was most likely used?
- A.
Flucytosine + acyclovir + saquinavir
- B.
Didanosine+ ganciclovir +zidovudine
- C.
Vidarabine + foscarnet +didanosine
- D.
Ribavirin + saquinavir + zidovudine
- E.
Zidovudine + lamivudine + saquinavir
Correct Answer
E. Zidovudine + lamivudine + saquinavirExplanation
The most likely triple drug regimen used in this case is Zidovudine + lamivudine + saquinavir. This combination is commonly used in HAART for HIV-positive patients. Zidovudine and lamivudine are nucleoside reverse transcriptase inhibitors (NRTIs) that work by inhibiting the reverse transcriptase enzyme, preventing the replication of the HIV virus. Saquinavir is a protease inhibitor (PI) that inhibits the protease enzyme, preventing the cleavage of viral polyproteins and the production of mature virus particles. This combination of drugs helps to suppress viral replication and improve the CD4 lymphocyte count in HIV-positive individuals.Rate this question:
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- 2.
A 28-year-old, HIV positive man with an extensive history of treatment with many antiretroviral agents, is presently following an antiretroviral therapy which includes saquinavir. Which of the following steps of the viral growth cycle is inhibited by this drug?
- A.
Attachment
- B.
Penetration
- C.
Uncoating
- D.
Early translation
- E.
Transcription
- F.
Late translation
- G.
Proteolytic cleavage
Correct Answer
G. Proteolytic cleavageExplanation
Saquinavir is a protease inhibitor, which means it inhibits the proteolytic cleavage step of the viral growth cycle. Proteolytic cleavage is a crucial step in the maturation of the HIV virus, where the viral polyprotein is cleaved into individual functional proteins by the viral protease enzyme. By inhibiting this step, saquinavir prevents the formation of mature and infectious viral particles, thus reducing viral replication and the progression of HIV infection.Rate this question:
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- 3.
A 34-year-old man with AIDS presented to the clinic for a follow up visit. He was concerned because he noticed a growth on his neck. He has been following an HAART (Highly Active Antiretroviral Therapy) for 4 months. Physical examination disclosed an accumulation of fat on his upper back. Pertinent lab results were: total cholesterol 380 mg/dL, triglycerides 420 mg/dL, blood glucose 240 mg/dL. These lab values were within normal limits before starting the HAART. Which of the following drugs most likely caused the signs and the lab values of this patient?
- A.
Amantadine
- B.
Foscarnet
- C.
Enfuvirtide
- D.
Atazanavir
- E.
Saquinavir
Correct Answer
E. SaquinavirExplanation
The patient's presentation of fat accumulation on the upper back, along with elevated total cholesterol, triglycerides, and blood glucose levels, is consistent with a condition called lipodystrophy, which is a known side effect of certain antiretroviral drugs. Saquinavir, a protease inhibitor commonly used in HAART, has been associated with the development of lipodystrophy. Therefore, Saquinavir is the most likely drug responsible for the signs and lab values observed in this patient.Rate this question:
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- 4.
A 37-year-old woman with AIDS was found to have a CD4 lymphocyte count of 45 cell/mm at the last control visit. The patient had an extensive history of treatment with 3 h a variety of antiretroviral drugs and has been currently taking zidovudine, lamivudine and ritonavir. The physician decided to add a new drug that prevents fusion and penetration of the HIV into the host’s cell. Which of the following drugs was most likely prescribed?
- A.
Ribavirin
- B.
Amantadine
- C.
Didanosine
- D.
Enfuvirtide
- E.
Indinavir
- F.
Saquinavir
Correct Answer
D. EnfuvirtideExplanation
The patient has a low CD4 lymphocyte count, indicating a compromised immune system due to AIDS. The physician decides to add a new drug that prevents fusion and penetration of HIV into the host's cell. Enfuvirtide, a fusion inhibitor, is the most likely drug prescribed in this scenario. Ribavirin, Amantadine, Didanosine, Indinavir, and Saquinavir are not fusion inhibitors and would not be appropriate in this case.Rate this question:
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- 5.
) A 32-year-old man was diagnosed with HIV and was treated with an antiviral drug. Two months later, he developed nephrolithiasis, insulin resistance, fat redistribution and hyperlipidemia. Which of the following antiviral agents most likely caused these adverse effects?
- A.
Efavirenz
- B.
Indinavir
- C.
Zidovudine
- D.
Raltegravir
Correct Answer
B. IndinavirExplanation
Indinavir is a protease inhibitor used in the treatment of HIV. It is known to cause adverse effects such as nephrolithiasis (formation of kidney stones), insulin resistance, fat redistribution, and hyperlipidemia. These side effects are commonly associated with the use of indinavir and are not typically seen with other antiviral agents. Therefore, it is likely that indinavir is the cause of these adverse effects in the 32-year-old man.Rate this question:
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- 6.
What is the rationale behind treating an HIV patient with a protease inhibitor?
- A.
Curb viral proliferation by inhibiting the DNA-dependent RNA polymerase
- B.
Curb viral proliferation by preventing viral integration in infected cells
- C.
Curb viral proliferation by preventing reverse transcription in infected cells
- D.
Curb viral proliferation by preventing viral assembly following infection
- E.
Curb viral proliferation by preventing viral fusion and entry in the first place
Correct Answer
D. Curb viral proliferation by preventing viral assembly following infectionExplanation
Protease inhibitors are used to treat HIV patients because they curb viral proliferation by preventing viral assembly following infection. Protease is an enzyme that is necessary for the virus to assemble new viral particles. By inhibiting the protease, the virus is unable to properly assemble and release new copies of itself, thereby reducing viral proliferation. This helps to control the viral load in the patient and slow down the progression of the disease.Rate this question:
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- 7.
A 36-year-old HIV-infected man has displayed a steady increase in his viral load over the past 5-months. Molecular diagnostics reveal that the strain of HIV-1 he is infected with has developed a mutation in the active site of the reverse transcriptase enzyme. His treating physician removes the drug emtricitabine from his HAART regimen, and replaces it with a drug that targets the same enzyme and which his viral strain shows an increased susceptibility to. Which of the following drugs is added to this patient’s HAART regimen?
- A.
Abacavir
- B.
Lamivudine
- C.
Raltegravir
- D.
Lopinavir
- E.
Delavirdine
Correct Answer
E. DelavirdineExplanation
The patient's HIV-1 strain has developed a mutation in the active site of the reverse transcriptase enzyme. This mutation has caused an increase in the viral load. The physician decides to remove emtricitabine, which targets the reverse transcriptase enzyme, from the patient's HAART regimen. Instead, the physician adds a drug that targets the same enzyme but is more effective against the patient's viral strain. Therefore, delavirdine, which is known to target the reverse transcriptase enzyme, is added to the patient's HAART regimen.Rate this question:
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- 8.
A composite virus has the nucleic of poliovirus and the capsid of hepatitis A. If a permissive host can be found, what would be the outcome be?
- A.
Pure hepatitis A
- B.
More composite virus
- C.
Pure poliovirus
- D.
A mixture of hepatitis A, poliovirus and composite virus
Correct Answer
C. Pure poliovirusExplanation
If a permissive host can be found, the outcome would be pure poliovirus. This is because the nucleic acid of the poliovirus and the capsid of hepatitis A are combined in the composite virus. However, when the composite virus infects a permissive host, it is likely that the host's cellular machinery will recognize and use the capsid of the hepatitis A virus to package the nucleic acid of the poliovirus, resulting in the production of pure poliovirus particles.Rate this question:
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- 9.
A 45-year-old man presents with an ulcerating lesion at the inner canthus of right eye. A biopsy shows a malignant tumor composed of basaloid cells with hyperchromatic nuclei. The tumor cells show prominent nuclear palisading. Which of the following features best describes the most likely initial mode of spread of the patient’s tumor?
- A.
Distant metastasis
- B.
Local tissue invasion
- C.
Seeding of body cavities
- D.
Hematogenous spread
- E.
Lymphatic spread
Correct Answer
B. Local tissue invasionExplanation
The presence of an ulcerating lesion at the inner canthus of the eye, along with a biopsy showing a malignant tumor composed of basaloid cells with hyperchromatic nuclei and prominent nuclear palisading, suggests that the tumor is locally invading the surrounding tissue. Local tissue invasion refers to the spread of tumor cells into nearby structures and is a common mode of spread for basal cell carcinomas, which this patient likely has. This explanation is supported by the information given in the question stem.Rate this question:
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- 10.
A 70-year-old male present with painless hematuria. Cystoscopy shows a malignant tumor invading deep into the muscle layer. The tumor is composed of pleomorphic, anaplastic cells with nuclear atypia and many mitotic figures. Which of the following features refer to his stage of the disease rather than the grade of tumor?
- A.
High number of mitotic figures
- B.
High degree of anaplasia
- C.
Tumor penetration into muscular layer
- D.
Higher nuclear atypia
- E.
Degree of pleomorphism
Correct Answer
C. Tumor penetration into muscular layerExplanation
The presence of tumor penetration into the muscular layer refers to the stage of the disease rather than the grade of the tumor. Staging refers to the extent or spread of the cancer, while grading refers to the appearance of the cancer cells under a microscope. In this case, the fact that the tumor has invaded deep into the muscle layer indicates a more advanced stage of the disease, regardless of the grade of the tumor.Rate this question:
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- 11.
Organ grafts between genetically identical individuals such as identical twins are characterized by the following statement:
- A.
Not rejected even with no immunosuppression
- B.
Subject to hyperacute rejection
- C.
Rejected slowly due to minor histocompatibility antigens
- D.
Subject to chronic rejection
- E.
Rejected immediately due to alloincompatibility
Correct Answer
A. Not rejected even with no immunosuppressionExplanation
Organ grafts between genetically identical individuals, such as identical twins, are not rejected even with no immunosuppression because they have the same genetic makeup. This means that the immune system of the recipient recognizes the transplanted organ as "self" and does not mount an immune response against it. As a result, there is no need for immunosuppressive drugs to prevent rejection of the organ.Rate this question:
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- 12.
A patient requires a bone marrow transplant and his brother volunteers to be the donor. Serological tests reveal complete compatibility between the donor and recipient. The laboratory carried out mixed lymphocyte reactions (MLR) between donor and recipient with the following result: a large increase in numbers of the non-irradiated cells of the brother, but minimal increase in numbers of the non-irradiated cells of the patient. What would be the most likely outcome?
- A.
Hyperacute graft rejection
- B.
Graft versus host disease
- C.
Host versus graft reaction
- D.
Long term graft survival
Correct Answer
B. Graft versus host diseaseExplanation
The most likely outcome in this scenario is graft versus host disease. The MLR result indicates that the donor's lymphocytes are recognizing and attacking the recipient's cells, leading to an increase in the donor's cells but not the patient's cells. This immune response can cause significant damage to the recipient's tissues and organs, resulting in graft versus host disease.Rate this question:
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