Microbiology — HIV and Viral Hepatitis, NMC MBBS licence examination syllabus (Nepal Medical Council).
HIV and viral hepatitis — NMC-style practice questions
Practice questions written for this chapter. These are not past NMC papers.
📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter.
Level 1–2 — recall and understanding
Q1. HIV primarily infects which cell?
A. The neutrophil
B. The CD4 T-HELPER lymphocyte
C. The erythrocyte
D. The hepatocyte
ANSWER: B — the CD4 T-helper cell.
Why: the CD4 cell coordinates cell-mediated immunity, which
defends against intracellular organisms. Its depletion
explains the pattern of opportunistic infection that follows.
LEARNING POINT: the CD4 count is a measure of remaining
immunity, and therefore predicts which infections occur.
Q2. Which hepatitis viruses are capable of causing CHRONIC
infection?
A. A and E
B. B, C and D
C. A and B only
D. All five equally
ANSWER: B — B, C and D.
Why: the blood-borne viruses can persist; the faecal-oral
viruses (A and E) cause acute illness only. Chronic infection
is what leads to cirrhosis and hepatocellular carcinoma.
LEARNING POINT: route of transmission predicts chronicity.
Level 3–4 — application and clinical reasoning
Q3. A man tests HIV-negative 10 days after a high-risk
exposure. The correct interpretation is:
A. He is definitely not infected
B. He may be within the WINDOW PERIOD — repeat testing is
required
C. He needs no further follow-up
D. The test was performed incorrectly
ANSWER: B.
Why: between infection and detectability, a person is infected
and infectious but tests negative. A single early negative
test excludes nothing.
LEARNING POINT: also assess urgently whether post-exposure
prophylaxis is indicated — that decision is time-critical.
Q4. A health worker has HBsAg negative, anti-HBs POSITIVE,
anti-HBc NEGATIVE. This indicates:
A. Past hepatitis B infection, now resolved
B. Chronic hepatitis B
C. Successful VACCINATION
D. Acute hepatitis B
ANSWER: C — vaccination.
Why: vaccination produces antibody to the surface antigen
only. Core antibody appears only after infection with the
whole virus, so its ABSENCE means she has never been infected.
LEARNING POINT: anti-HBc is the marker that separates
vaccination from past infection.
Q5. A man with untreated HIV and a very low CD4 count has
weeks of dry cough, exertional desaturation and few chest
signs. Which is most consistent?
A. Pneumocystis pneumonia
B. Acute bacterial pneumonia
C. Pulmonary oedema
D. Asthma
ANSWER: A — Pneumocystis pneumonia.
Why: a subacute dry cough with marked desaturation on exertion
and a relatively unimpressive examination in advanced
immunosuppression is characteristic.
LEARNING POINT: TB occurs at ANY CD4 count and must still be
actively excluded, not assumed away.
Level 5 — exception-based
Q6. Which viral hepatitis carries a substantially increased
risk of severe or fulminant disease in PREGNANCY?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. HEPATITIS E
ANSWER: D — hepatitis E.
Why: hepatitis E is usually mild and self-limiting, but in
pregnancy, particularly the third trimester, the risk of
severe and fulminant hepatic failure is substantially higher.
LEARNING POINT: a jaundiced pregnant woman in a waterborne
outbreak needs closer monitoring, not routine management.
Q7. Why does hepatitis D only occur in people who already
have hepatitis B?
A. They share the same vaccine
B. Hepatitis D cannot replicate without hepatitis B
C. They are transmitted only together
D. Hepatitis D is a mutation of hepatitis B
ANSWER: B.
Why: hepatitis D is dependent on hepatitis B for replication,
so it can only infect people already carrying B — and it makes
their liver disease worse.
LEARNING POINT: vaccinating against hepatitis B therefore
prevents hepatitis D as well.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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