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Imaging 14:77-80 (2002)
© 2002 The British Institute of Radiology

Multiple choice questionnaire

Multiple-choice questionnaire: Imaging in AIDS/HIV


   Introduction
Top
 Introduction
Questions
 
The following multiple-choice questions are based entirely on the contents of this issue of Imaging and are accredited by the Royal College of Radiologists for continuing medical education. Photocopy and complete the reader response form on pages 81–82—answers must be received by the BIR no later than 12 July 2002. If you achieve a score of 75% or a above you will be awarded 1 Category One CPD Credit.

Up to 6 Credits per year may be obtained through journal CME.

Answers will be printed in Imaging 14(3), and will also be available on the BIR's website www.bir.org.uk following the above submission deadline.


   Questions
Top
 Introduction
 Questions
 
Question 1
Regarding central nervous system (CNS) lymphoma in AIDS:

  1. The primary form presents as a solitary lesion in the vast majority of cases.
  2. Detection of Epstein-Barr virus DNA in cerebrospinal fluid (CSF) by the polymerase chain reaction (PCR) is highly sensitive and specific for diagnosis of the primary form.
  3. Haemorrhage in lesions is common.
  4. The metastatic form typically presents as a focal enhancing mass.
  5. Magnetic resonance spectroscopy reveals metabolite peaks of choline (Ch) and N-acetyl-L-aspartate to be low.

Question 2
Regarding the central nervous system (CNS) in HIV infection:

  1. Cytomegalovirus (CMV) is the most common viral infection.
  2. Highly active anti-retroviral therapy (HAART) significantly prolongs the survival of patients with progressive multifocal leucoencephalopathy (PML).
  3. The target sign on CT is pathognomic for a tuberculoma.
  4. Gummas are the most frequent imaging feature of neurosyphilis.
  5. The presence of enlarged Virchow–Robin spaces is diagnostic of cryptococcal disease.

Question 3
The following are true of central nervous system involvement in AIDS:

  1. HIV encephalopathy (HIVE) is the commonest cause of neurological disease.
  2. In HIVE, MRI will show bilateral symmetrical abnormalities of high signal on T2 weighted imaging.
  3. The lesions of HIVE typically enhance following gadolinium.
  4. Progressive multifocal leucoencephalopathy (PML) is associated with the Jakob Creutzfeldt papova virus.
  5. Cytomegalovirus encephalitis is easily differentiated from HIVE by its imaging characteristics.

Question 4
Regarding central nervous system infection in HIV:

  1. Toxoplasmosis always has a multifocal distribution.
  2. Toxoplasmosis typically affects the basal ganglia.
  3. MRI has a greater sensitivity than CT in the diagnosis of toxoplasmosis.
  4. Cryptococcal meningitis usually has diagnostic CT appearances.
  5. Tuberculomas usually occur at the grey–white matter interface.

Question 5
Concerning central nervous system and spinal imaging in HIV infection:

  1. HIV encephalopathy may cause a myelitis.
  2. Myelopathy causes high signal of the white matter tracts on T2 weighted MRI.
  3. Cerebral infarcts may occur secondary to infection.
  4. Ventriculitis is a feature of both cytomegalovirus and herpes viruses.
  5. Subependymal enhancement is a feature of ventriculitis on MRI.

Question 6
Concerning abdominal infections in HIV disease:

  1. Proximal small bowel involvement is a characteristic feature of Mycobacterium tuberculosis (MTB).
  2. Focal liver and splenic lesions occur more commonly in MTB infection than in Mycobacterium avium-intracellulare (MAI) infection.
  3. MAI is a commoner cause of necrotic lymph nodes than MTB.
  4. The ascitic fluid in MTB infection is characteristically of high attenuation.
  5. Both MAI and MTB can cause focal renal lesions.

Question 7
Concerning cytomegalovirus (CMV) infection of the gastrointestinal tract in HIV infection:

  1. CMV colitis classically affects the caecum and ascending colon.
  2. CMV colitis causes multiple ulcers, which can be seen on a barium enema.
  3. CT does not contribute to the diagnosis in CMV colitis.
  4. Pneumatosis coli is a recognized complication of CMV colitis.
  5. Lymphadenopathy is common.

Question 8
The following are true of gastrointestinal tract infection in HIV disease:

  1. Cytomegalovirus may result in acalculous cholecystitis.
  2. Oesophageal ulcers on barium studies may be due to candidiasis.
  3. Candidiasis may cause multiple liver lesions.
  4. Cryptosporidiosis is a cause of biliary tract dilation.
  5. Low attenuation nodes at CT may be due to histoplasmosis.

Question 9
Regarding gastrointestinal tract malignancies in HIV infection:

  1. Lymphoma is the commonest tumour.
  2. There is an increased incidence of anorectal carcinoma.
  3. Kaposi's sarcoma (KS) has a prediliction for the terminal ileum.
  4. Barium features of KS include submucosal nodules.
  5. Nodes involved by KS are frequently hyperechoic on ultrasound.

Question 10
Complications of HIV therapy include:

  1. Pancreatitis.
  2. Urolithiasis.
  3. Metabolic alkalosis.
  4. Hyperlipidaemia.
  5. Gynaecomastia.

Question 11
Concerning the epidemiology of HIV infection:

  1. AIDS was formally described in 1982, with isolation of the virus in 1983.
  2. Approximately 1% of the world's population in the 15–49 years age group is affected.
  3. Heterosexual transmission accounts for 80% of cases worldwide.
  4. The male to female ratio is currently 20:1.
  5. HIV in children is due to maternal transmission in 90% of cases.

Question 12
Regarding highly active anti-retroviral therapy (HAART):

  1. There are three main categories.
  2. Viral infections are less common in patients on HAART.
  3. Opportunistic infection prophylactic therapy must be continued.
  4. Mycobacterium avium complex remains the most common mycobacterial infection.
  5. Immune reconstitution inflammatory syndrome (IRIS) occurs a short period after institution of therapy.

Question 13
Regarding inflammatory and rheumatic manifestations of HIV infection:

  1. They tend to be a late feature of the disease.
  2. Psoriasis occurs with increased frequency.
  3. Reiter's disease causes a symmetrical polyarthropathy.
  4. Primary HIV arthropathy is an erosive arthropathy.
  5. Myositis may be seen on bone scintigraphy.

Question 14
Concerning musculoskeletal infection in HIV disease:

  1. It is usually caused by opportunistic organisms.
  2. The commonest bone abnormality is osteomyelitis.
  3. Hyperechoic muscle fibres seen at ultrasound would be consistent with pyomyositis.
  4. Bacillary angiomatosis causes sclerotic bone lesions.
  5. Poncet's disease is associated with tuberculosis (TB) infection.

Question 15
The following are true of musculoskeletal neoplasia in HIV infection:

  1. It is a late feature.
  2. Hodgkin's lymphoma is the commonest neoplasm.
  3. Non-Hodgkin's lymphoma invariably causes lytic lesions.
  4. Kaposi's sarcoma typically causes increased radionuclide uptake on bone scintigraphy.
  5. Kaposi's sarcoma is frequently associated with periosteal reaction.

Question 16
Regarding musculoskeletal involvement in HIV infection:

  1. Avascular necrosis (AVN) may be due to HIV itself.
  2. AVN typically involves the humeral head.
  3. The double line sign on MRI is characteristic of AVN.
  4. On T1 weighted MRI sequences, reduced marrow signal is a feature of anaemia.
  5. Drug therapy may be a cause of myopathy.

Question 17
The following are true of respiratory tract infection in HIV disease:

  1. Pneumocystis carinii is the commonest infection.
  2. Common radiographic features of Pneumocystis carinii pneumonia are perihilar ground-glass or reticulonodular shadowing.
  3. The radiology of tuberculosis is the same in the HIV infected and immunocompetent population.
  4. Cryptococcus is the commonest fungal infection.
  5. Miliary disease is common in Mycobacterium avium complex infection.

Question 18
The following are true of Pneumocystis carinii pneumonia (PCP):

  1. The chest radiograph may be normal.
  2. Those on pentamidine prophylaxis tend to get lower lobe infection.
  3. Calcified nodes may be a feature.
  4. CT thorax typically shows a ground-glass appearance.
  5. Pneumatocoeles are a feature in up to 40%.

Question 19
Concerning fungal respiratory infections in HIV disease:

  1. They are the commonest cause of infection.
  2. Cryptococcus can cause miliary nodules.
  3. Aspergillus, when causing mycetoma, is usually secondary to tuberculosis or Pneumocystis carinii pneumonia.
  4. A single mass is the commonest manifestation of nocardia.
  5. Histoplasma usually results in nodules smaller than 5 mm.

Question 20
Regarding chest neoplasms in HIV infection:

  1. Only the lung parenchyma is at risk of involvement.
  2. Lung carcinoma is usually squamous in type.
  3. Kaposi's will affect the lungs in less than 10% of those with cutaneous involvement.
  4. AIDS-related lymphoma is typically non-Hodgkin's.
  5. AIDS-related lymphoma is classically extranodal.

Question 21
Concerning the epidemiology of HIV infection in childhood:

  1. It is primarily due to vertical transmission.
  2. Breast feeding increases the risks of vertical transmission.
  3. HIV antibody detection is a reliable diagnostic tool at all ages.
  4. Polymerase chain reaction testing is the investigation of choice.
  5. In the UK, the majority of those infected by vertical transmission develop AIDS in infancy.

Question 22
The following are correct of pulmonary manifestations of HIV infection in children:

  1. Involvement of the respiratory tract is uncommon.
  2. Pneumocystis carinii pneumonia (PCP) is the commonest opportunistic infection.
  3. PCP is frequently associated with pleural effusions.
  4. Mycobacterium tuberculosis (MTB) disease is often miliary.
  5. Lymphocytic interstitial pneumonia (LIP) occurs in one-third of cases.

Question 23
Regarding gastrointestinal tract manifestations of HIV infection in children:

  1. Hepatosplenomegaly is uncommon.
  2. Cytomegalovirus is the commonest cause of enteritis.
  3. Mesenteric and retroperitoneal nodes are a recognized feature of Mycobacterium avium-intracellulare (MAI) infection.
  4. Intussusception is a recognized complication.
  5. Toxic megacolon is not a complication in childhood.

Question 24
The following statements are true of HIV infection in childhood:

  1. Constrictive cardiomyopathy is the commonest cardiac feature.
  2. The central nervous system is less often involved than in adults.
  3. Renal candidiasis can be diagnosed on ultrasound.
  4. Bilateral echogenic kidneys on ultrasound are a finding of HIV nephropathy.
  5. Positron emission spectroscopy is useful in the detection of HIV encephalopathy.





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