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Test 5: Management of patients on anti­retroviral treatment

  1. When should prophylactic co-trimoxazole be stopped?
    • When antiretroviral treatment is started
    • When the patient starts to feel better
    • When the CD4 count has risen above 200 cells/µl
    • When the patient has been on antiretroviral treatment for a year
  2. When should the routine follow-up visits be done during the first four months after starting antiretroviral treatment?
    • Weekly
    • Every two weeks
    • Monthly (four, eight and 12 weeks)
    • At six and 12 weeks
  3. When should education and counselling be provided?
    • During the preparation of antiretroviral treatment only
    • At the first treatment visit only
    • During the first three months of antiretroviral treatment only
    • At every visit
  4. Who are the members of the multi­disciplinary team at the antiretroviral clinic?
    • The doctors
    • Both the doctors and the nurses
    • All the staff
    • Both the staff and patients
  5. What should be done at each follow up visit?
    • The patient should be weighed.
    • The CD4 count should be measured.
    • The viral load should be measured.
    • The serum ALT (alanine aminotransferase) should be measured.
  6. How often should medicines be collected from the clinic?
    • Every week
    • Every one to three months
    • Every four to five months
    • Every six months
  7. A haemoglobin (Hb) level and differential count at months 3 and 6 should be measured in patients receiving:
    • Nevirapine
    • d4T
    • 3TC
    • AZT
  8. What monitoring for side effects is needed for TDF?
    • Creatine clearance monitoring
    • Full blood count
    • Fasting serum cholesterol and triglyceride
    • Serum ALT (alanine aminotransferase)
  9. How often should a patient be seen by the doctor or nurse if antiretroviral treatment is successful?
    • Every month
    • Every three months
    • Every six months
    • Every year
  10. For how long can treatment be successful?
    • Usually for a year
    • From one to five years
    • From five to 10 years
    • More than 10 years
  11. What indicates treatment failure?
    • The development of immune reconstruction inflammatory syndrome
    • A CD4 count above 200 cells/µl
    • An undetectable viral load
    • A viral load above 1000 copies/ml
  12. What should be done if the second-line of treatment fails in spite of excellent adherence?
    • Refer the patient for resistance testing
    • Change back to the first-line treatment
    • Use both first- and second-line treatment together
    • Add rifampicin and co-trimoxazole
  13. What are the dangers of poor adherence?
    • Treatment failure
    • Serious side effects
    • Immune reconstitution inflammatory syndrome
    • It will upset the clinic staff
  14. How can adherence be improved?
    • By taking both the morning and evening medication at lunch time
    • By taking medication three times a week
    • By setting an alarm clock as a reminder
    • By collecting the medication from the clinic each day
  15. How can antiretroviral drug resistance be avoided?
    • Use monotherapy (one drug only)
    • Use two drugs together from the same class
    • Take a combination of at least three drugs from two classes
    • Take at least 60% of all doses
  16. What is the commonest cause of treatment failure?
    • Poor adherence
    • Pregnancy
    • Taking antiretroviral drugs with meals
    • Viral ‘blips’
  17. Rifampicin markedly reduces the blood levels of:
    • ‘Nucs’ such as AZT
    • ‘Non-nucs’ such as efavirenz
    • ‘PIs’ such as Aluvia
    • All antiretroviral drugs
  18. What should be done if a patient has a severe drug reaction to an antiretroviral drug?
    • Stop that drug.
    • Stop all antiretroviral drugs.
    • Continue the treatment but give steroids such as intravenous prednisone.
    • Continue the treatment but give an oral antihistamine.
  19. Which patients are at the greatest risk of immune reconstitution inflammatory syndrome?
    • Patients who are generally well when the antiretroviral treatment is started
    • Patients with a low viral load
    • Patients with a very low CD4 count
    • Patients who are younger than 20 years old
  20. Which HIV-associated infection is commonest with immune reconstitution inflammatory syndrome in South Africa?
    • Cryptococcal meningitis
    • Cytomegalovirus retinitis
    • Leprosy
    • Tuberculosis