Question

Write an Explanation after each answer

Chen Yau, a 3-year-old Asian-American man, was admitted with symptoms of a depressed immune system, including oral and groin candidiasis (thrush) and a herpesvirus infection. This is his fourth admission in less than 2 years. Mr. Yau has engaged in anal and oral homosexual intercourse since 20 years of age. At 30 years old, he tested positive for HIV. Chen has had four inpatient and three outpatient admissions between 30 and 32 years of age. His previous admissions were for Pneumocystis carinii pneumonia, anemia, gastrointestinal problems, and Kaposi sarcoma of the skin. Mr. Yau takes several medications to control his symptoms, including zidovudine (Azidothymidine (AZT)). Mr. Yau’s most recent admission was preceded with symptoms of diarrhea, loss of appetite, a 10-pound weight loss over a 2-week period, a nonproductive cough, some shortness of breath, night sweats, fatigue, and a perianal lesion. On admission, physical examination reveals painful enlargement of multiple lymph nodes, whites exudate, and inflammation of the mouth and back of the throat, which is consistent with candidiasis, and purplish brown palpable lesions on his arms, legs, and trunk, which are consistent with Kaposi sarcoma. A comprehensive baseline mental status examination reveals several subtle changes in personality and some mild confusion. Mr. Yau demonstrates limits in his visual field, and an ophthalmoscopic examination of the eye shows evidence of inflammation and hemorrhage of the retina that is consistent with cytomegalovirus. Laboratory studies reveal a low white cell count with a few lymphocytes, a reduced ratio of T4 helper cells to T8 suppressor cells, a positive stool for the Cryptosporidium parasite, and an x-ray with diffuse infiltrates compatible with Pneumocystis carinii pneumonia. During this most recent admission, Mr. Yau became extremely confused and also became unable to fully control the muscles of his feet and legs. His condition continued to deteriorate until his death in the hospital a few weeks after his admission.

1. Acquired immune deficiency syndrome (AIDS) manifests as reduced resistance to opportunistic infections and malignancies because of: A. An acquired deficiency of isoimmunity B. An exaggerated immune response to counteract a T-cell deficiency C. Impaired functioning of one of the immune inflammatory responses D. Deficiency of antigen (HIV) recognition.

2. The T4 helper cell to T8 suppressor cell ratio is normally about 2:1. This ratio in Mr. Yau was severely reduced because: A. Bone marrow depression reduces hemoglobin and hematocrit levels. B. HIV infects and kills the host T4 cells, decreasing their numbers. C. The T8 suppressor cells are stimulated by HIV and their numbers increase. D. y-Interferon is reduced, thereby reducing cytotoxic T8 suppressor cell activity.

3. Pneumocystis carinii, a protozoan that is usually not pathogenic, caused severe respiratory problems for Mr. Yau because of his: A. T-cell function impairment B. Lack of knowledge about his disease C. Recent exposure to human immunodeficiency virus D. Immunosuppression from the AZT

4. Mr. Yau’s confusion and distal peripheral neuropathy are not supported with any serological findings for neurological or infectious disease. His peripheral neuropathy was most likely caused by: A. Primary or secondary central nervous system lymphoma B. Toxoplasma, a protozoan infection of the central nervous system C. Disturbance in normal brain patterns from drug therapy D. Presence of HIV in peripheral nerves and the central nervous system.

Answer 1

1. C

In HIV, there is decreased CD 4 T cells and this the cell mediated immune responses are decreased

There is neither exaggerated immune responses in HIV nor deficiency in HIV recognition

2. B

I'm HIV, the virus infects the CD4 T cells that later be destroy by the virus, thus decreasing their numbers in the circulation.

There is some bone marrow depression in HIV but that it not enough to produce low CD4 counts

3. A

Actually viral and parasitic infections are tackled by the lymphocytes and in HIV, there is low lymphocytes counts and thus the persons are prone for opportunistic infections.

This occurs in the late stages of the disease

4. D

HIV in the late stages can cause dementia, confusion due to the presence of HIV in the CNS and also causes peripheral neuropathy due to the presence of HIV in the peripheral nerves

CNS lymphoma presents as seizures, headache and focal neurological deficits

Hope this helps.... Thank you!!!