Paediatric infections: lymphoid interstitial pneumonitis in HIV: practice question

A Pediatrics 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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Pediatrics · Paediatric infections: lymphoid interstitial pneumonitis in HIV

Sample item

An 8-year-old with perinatally acquired HIV has chronic cough, bilateral painless parotid enlargement, generalised lymphadenopathy and finger clubbing. Chest radiograph shows bilateral reticulonodular infiltrates, and sputum for AFB is negative. What is the most likely lung diagnosis?

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

The answer and the reasoning

D. Lymphoid interstitial pneumonitis

LIP is a chronic lymphoproliferative lung disease in older HIV-infected children, linked with EBV, and presents with parotid enlargement, lymphadenopathy, clubbing and reticulonodular infiltrates. PCP presents acutely with hypoxia in infants. Antiretroviral therapy is the main treatment, with steroids for hypoxia.

Option by option

  • A. Pneumocystis jirovecii pneumonia

    PCP is an acute hypoxic illness in young infants.

  • B. Bronchiectasis

    Bronchiectasis causes copious sputum and bronchial wall changes rather than parotid enlargement.

  • C. Miliary tuberculosis

    Miliary TB causes fever and weight loss with fine mottling and positive tests.

  • D. Lymphoid interstitial pneumonitis (correct)

    Correct. Parotid swelling, clubbing and a reticulonodular pattern in an older HIV-infected child indicate LIP.

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 Pediatrics question

What is the answer to this Pediatrics question?

The best answer is D, Lymphoid interstitial pneumonitis. LIP is a chronic lymphoproliferative lung disease in older HIV-infected children, linked with EBV, and presents with parotid enlargement, lymphadenopathy, clubbing and reticulonodular infiltrates.

Why is "Pneumocystis jirovecii pneumonia" not the answer?

PCP is an acute hypoxic illness in young infants.

Why is "Bronchiectasis" not the answer?

Bronchiectasis causes copious sputum and bronchial wall changes rather than parotid enlargement.

Why is "Miliary tuberculosis" not the answer?

Miliary TB causes fever and weight loss with fine mottling and positive tests.

What concept does this question test?

It tests Paediatric infections: lymphoid interstitial pneumonitis in HIV in Pediatrics. PCP presents acutely with hypoxia in infants. Antiretroviral therapy is the main treatment, with steroids for hypoxia.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Paediatric infections: lymphoid interstitial pneumonitis in HIV?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.