Neuroimaging: toxoplasmosis in HIV: practice question

A Radiology 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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Radiology · Neuroimaging: toxoplasmosis in HIV

Sample item

A patient with HIV and a CD4 count of 40 has multiple ring-enhancing lesions in the basal ganglia with surrounding oedema on CT. Which approach is appropriate?

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

The answer and the reasoning

D. Empirical treatment for toxoplasmosis and repeat imaging at 2 weeks

Multiple ring-enhancing basal ganglia lesions in advanced HIV are most often toxoplasmosis, and a trial of pyrimethamine and sulfadiazine is given with a repeat scan after 10 to 14 days. Failure to improve prompts biopsy to exclude primary CNS lymphoma. Lymphoma is often solitary, periventricular and hyperdense.

Option by option

  • A. No treatment and observe

    Untreated toxoplasmosis is fatal.

  • B. Immediate surgical resection of all lesions

    Surgery is unnecessary and risky for a likely infectious cause.

  • C. Immediate stereotactic radiotherapy

    Radiotherapy is for lymphoma only after confirmation.

  • D. Empirical treatment for toxoplasmosis and repeat imaging at 2 weeks (correct)

    Correct. Empirical therapy with early reassessment is standard.

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 Radiology question

What is the answer to this Radiology question?

The best answer is D, Empirical treatment for toxoplasmosis and repeat imaging at 2 weeks. Multiple ring-enhancing basal ganglia lesions in advanced HIV are most often toxoplasmosis, and a trial of pyrimethamine and sulfadiazine is given with a repeat scan after 10 to 14 days.

Why is "No treatment and observe" not the answer?

Untreated toxoplasmosis is fatal.

Why is "Immediate surgical resection of all lesions" not the answer?

Surgery is unnecessary and risky for a likely infectious cause.

Why is "Immediate stereotactic radiotherapy" not the answer?

Radiotherapy is for lymphoma only after confirmation.

What concept does this question test?

It tests Neuroimaging: toxoplasmosis in HIV in Radiology. Failure to improve prompts biopsy to exclude primary CNS lymphoma. Lymphoma is often solitary, periventricular and hyperdense.

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 Neuroimaging: toxoplasmosis in HIV?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.