Infectious diseases: immune reconstitution inflammatory syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: immune reconstitution inflammatory syndrome

Sample item

Four weeks after starting ART, a patient on treatment for TB develops fever and enlarging lymph nodes despite falling viral load and rising CD4 count. Cultures are negative for new organisms. What is this?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Paradoxical TB-associated immune reconstitution inflammatory syndrome

IRIS occurs after ART as a recovering immune system mounts an exaggerated response to a known or unmasked infection. Paradoxical IRIS is worsening of a treated condition despite virological response. ART and antitubercular drugs are continued, with NSAIDs or steroids for significant inflammation.

Option by option

  • A. Drug fever from rifampicin only

    Drug fever would not give new lymphadenopathy on this timeline.

  • B. Paradoxical TB-associated immune reconstitution inflammatory syndrome (correct)

    Correct. This describes paradoxical IRIS.

  • C. New opportunistic infection

    Negative cultures argue against a new infection.

  • D. Treatment failure from drug resistance

    Falling viral load argues against failure.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Paradoxical TB-associated immune reconstitution inflammatory syndrome. IRIS occurs after ART as a recovering immune system mounts an exaggerated response to a known or unmasked infection.

Why is "Drug fever from rifampicin only" not the answer?

Drug fever would not give new lymphadenopathy on this timeline.

Why is "New opportunistic infection" not the answer?

Negative cultures argue against a new infection.

Why is "Treatment failure from drug resistance" not the answer?

Falling viral load argues against failure.

What concept does this question test?

It tests Infectious diseases: immune reconstitution inflammatory syndrome in General Medicine. Paradoxical IRIS is worsening of a treated condition despite virological response. ART and antitubercular drugs are continued, with NSAIDs or steroids for significant inflammation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: immune reconstitution inflammatory syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.