A 28-year-old man is newly diagnosed with HIV, CD4 count 90 cells/µL. He also has TB meningitis, confirmed by CBNAAT on CSF as rifampicin-sensitive, and started first-line TB treatment with dexamethasone one week ago. He is conscious and improving. When should ART be started?

After 4 to 8 weeks of TB treatment

After TB treatment is completed

A 34-year-old man is newly diagnosed with HIV and drug-sensitive pulmonary TB at an ART centre. He started first-line TB treatment containing rifampicin 10 days ago. ART with tenofovir, lamivudine and dolutegravir (TLD) is now planned. What adjustment is needed?

Delay ART until TB treatment ends

A 30-year-old man from a village in Jharkhand has had fever with chills for 3 days. The bivalent rapid diagnostic test is positive for Plasmodium falciparum. He is alert, eating and drinking, and has no warning signs of severe malaria. Which treatment is appropriate?

Artemisinin-based combination therapy

Artesunate monotherapy for 3 days

Anti-TB, antiviral, antifungal and antiparasitic drugs

29 NEET-PG practice questions on Anti-TB, antiviral, antifungal and antiparasitic drugs, part of Pharmacology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 26-year-old man with rifampicin-resistant, fluoroquinolone-sensitive pulmonary TB is on the 6-month BPaLM regimen. At week 10 he reports burning numbness of both feet and blurred vision with poor colour discrimination. Haemoglobin has fallen from 12.8 to 9.6 g/dL and platelets to 90,000/µL. Which drug is the most likely cause?
1. AEthambutol
2. BMoxifloxacin
3. CBedaquiline
4. DLinezolid
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Answer: D · Linezolid
BPaLM is bedaquiline, pretomanid, linezolid and moxifloxacin. Linezolid blocks the 50S ribosomal subunit and also mitochondrial protein synthesis, so prolonged use causes myelosuppression, peripheral neuropathy and optic neuropathy, together with lactic acidosis. These effects depend on dose and duration, so blood counts, vision and neuropathy are checked regularly and linezolid is reduced or stopped as per NTEP guidance. Bedaquiline and moxifloxacin need ECG monitoring for QT prolongation.
- A: Ethambutol causes optic neuritis but is not part of BPaLM and does not suppress marrow.
- B: Moxifloxacin prolongs QT and harms tendons; it does not explain the cytopenias.
- C: Bedaquiline's main concern is QT prolongation, not marrow or nerve damage.
Question 2 · Hard
A 28-year-old man is newly diagnosed with HIV, CD4 count 90 cells/µL. He also has TB meningitis, confirmed by CBNAAT on CSF as rifampicin-sensitive, and started first-line TB treatment with dexamethasone one week ago. He is conscious and improving. When should ART be started?
1. AAfter 4 to 8 weeks of TB treatment
2. BAfter TB treatment is completed
3. CImmediately, within 2 weeks
4. DOnly once CD4 falls below 50
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Answer: A · After 4 to 8 weeks of TB treatment
In most people with HIV and TB, ART is started within 2 weeks of TB treatment because early ART reduces deaths. TB meningitis is the exception: early ART increases severe immune reconstitution inflammatory syndrome in the closed space of the skull and has not improved survival, so ART is deferred for 4 to 8 weeks. Cotrimoxazole prophylaxis is started now. Drug interactions with rifampicin, especially for dolutegravir, are planned in advance.
- B: Waiting until TB treatment ends increases deaths from HIV disease.
- C: Early ART in TB meningitis increases severe CNS IRIS and adverse events.
- D: ART is offered at any CD4 count, so this threshold is not used.
Question 3 · Easy
A 35-year-old man with HIV and cryptococcal meningitis is on IV amphotericin B deoxycholate, oral flucytosine and cotrimoxazole prophylaxis. On day 7 serum potassium is 2.6 mmol/L, magnesium is low and creatinine has risen from 0.8 to 1.6 mg/dL. Which drug is the most likely cause?
1. ACotrimoxazole
2. BFluconazole
3. CAmphotericin B
4. DFlucytosine
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Answer: C · Amphotericin B
Amphotericin B binds ergosterol in fungal membranes, but it also binds cholesterol in human cells, and the kidney is the main target. It constricts afferent arterioles and damages distal tubules, causing a fall in GFR, renal tubular acidosis and loss of potassium and magnesium. Saline loading before each dose, daily electrolytes with replacement, and lipid formulations reduce the damage. Flucytosine's main toxicity is bone marrow suppression.
- A: Trimethoprim in cotrimoxazole raises, not lowers, serum potassium.
- B: Fluconazole is not part of this regimen and rarely causes these changes.
- D: Flucytosine mainly causes marrow suppression and is itself cleared by the kidney.
Question 4 · Medium
A 34-year-old man is newly diagnosed with HIV and drug-sensitive pulmonary TB at an ART centre. He started first-line TB treatment containing rifampicin 10 days ago. ART with tenofovir, lamivudine and dolutegravir (TLD) is now planned. What adjustment is needed?
1. AStandard once-daily TLD
2. BDolutegravir 50 mg twice daily
3. CDolutegravir 25 mg once daily
4. DDelay ART until TB treatment ends
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Answer: B · Dolutegravir 50 mg twice daily
Rifampicin induces CYP3A4 and UGT1A1, which metabolise dolutegravir, and lowers its levels enough to risk treatment failure and resistance. The usual answer is an extra 50 mg of dolutegravir 12 hours after the TLD dose, giving 50 mg twice daily, continued for a short period after rifampicin stops. ART should not be delayed in HIV with TB; it is started within 2 weeks of TB treatment in most patients. TB meningitis is the exception, where ART is deferred for a few weeks.
- A: Standard once-daily dosing gives low dolutegravir levels with rifampicin.
- C: Lowering the dose would make the interaction worse.
- D: Delaying ART until TB treatment ends increases deaths.
Question 5 · Medium
A 30-year-old man from a village in Jharkhand has had fever with chills for 3 days. The bivalent rapid diagnostic test is positive for Plasmodium falciparum. He is alert, eating and drinking, and has no warning signs of severe malaria. Which treatment is appropriate?
1. AChloroquine for 3 days
2. BArtemisinin-based combination therapy
3. CArtesunate monotherapy for 3 days
4. DPrimaquine alone for 14 days
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Answer: B · Artemisinin-based combination therapy
Uncomplicated falciparum malaria is treated with an artemisinin-based combination therapy (ACT), in which a fast-acting artemisinin is paired with a longer-acting partner drug to clear parasites and protect against resistance. India's national guidelines use artesunate plus sulfadoxine-pyrimethamine in most states and artemether-lumefantrine in the north-eastern states, with a single low dose of primaquine to kill gametocytes and reduce transmission. Chloroquine is no longer used for falciparum because of widespread resistance. Artemisinin monotherapy is not used, as it encourages resistance.
- A: P. falciparum in India is widely resistant to chloroquine.
- C: Artemisinin monotherapy promotes resistance and has a high relapse of parasitaemia.
- D: Primaquine does not clear the blood-stage parasites causing his illness.
Question 6 · Medium
A 35-year-old man is a household contact of his wife, who has sputum-positive, drug-sensitive pulmonary TB. He has no symptoms, his chest X-ray is normal and he is HIV-negative. Consider four statements about TB preventive treatment (TPT) under NTEP: 1. Active TB must be ruled out before TPT is started. 2. Weekly isoniazid with rifapentine for 12 weeks (3HP) is an option for him. 3. Daily isoniazid for 6 months is an option for him. 4. He is not eligible, as TPT is given only to contacts under 5 years of age. Which statements are correct?
1. A1, 2 and 3 only
2. B1 and 4 only
3. C1 and 2 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 7 · Hard
A 45-year-old woman in week 4 of first-line treatment for pulmonary TB has nausea, vomiting and yellow eyes. ALT is 320 U/L (upper limit 40 U/L) and bilirubin 4.2 mg/dL. HBsAg, IgM anti-HAV and IgM anti-HEV are negative, and she does not drink alcohol. What is the most appropriate management?
1. ASwitch to the shorter MDR-TB regimen
2. BContinue all drugs; repeat LFTs in a week
3. CStop HRZ; reintroduce one by one after recovery
4. DStop only pyrazinamide; continue the rest
Answer and explanation in LearnFree account
Question 8 · Medium
A 38-year-old man with HIV, started on zidovudine, lamivudine and efavirenz 4 months ago because of kidney disease, comes to the ART centre with fatigue and breathlessness on exertion. Hb is 6.8 g/dL, MCV 112 fL, and serum B12 and folate are normal. Which drug is the most likely cause?
1. ALamivudine
2. BEfavirenz
3. CZidovudine
4. DTenofovir
Answer and explanation in LearnFree account
Question 9 · Easy
A 19-year-old man from Gujarat has fever with chills every other day, and his blood smear shows Plasmodium vivax. He is started on chloroquine, and primaquine is planned for 14 days. Which test should ideally be done before primaquine is started?
1. AECG for the QT interval
2. BLiver function tests
3. CG6PD deficiency test
4. DSerum creatinine
Answer and explanation in LearnFree account
Question 10 · Medium
A 60-year-old man in the ICU has a central line, is on parenteral nutrition and has received broad-spectrum antibiotics for 2 weeks. Blood cultures grow Candida glabrata, and IV caspofungin is started. How does caspofungin act?
1. AInhibits beta-1,3-glucan synthesis
2. BInhibits lanosterol 14-alpha-demethylase
3. CBinds ergosterol and forms pores
4. DInhibits fungal DNA and RNA synthesis
Answer and explanation in LearnFree account
Question 11 · Easy
A 65-year-old man has painful vesicles over the left forehead and the tip of his nose and is started on oral acyclovir for herpes zoster ophthalmicus. What gives acyclovir its selective toxicity for virus-infected cells?
1. AInhibition of viral neuraminidase
2. BBlockade of viral uncoating
3. CActivation by viral thymidine kinase
4. DInhibition of viral integrase
Answer and explanation in LearnFree account
Question 12 · Easy
A 32-year-old woman starts treatment for pulmonary TB at a DOTS centre. On day 3 she returns, worried that her urine and tears have turned orange-red and her soft contact lenses are stained. Her eyes are not yellow. What is the most appropriate advice?
1. AHarmless colour from rifampicin; continue
2. BHaematuria from isoniazid; stop it
3. CJaundice from pyrazinamide; stop all drugs
4. DMyoglobinuria from ethambutol; check CK
Answer and explanation in LearnFree account
Question 13 · Medium
A 42-year-old man has chronic hepatitis C with high HCV RNA and compensated liver disease. He is started on sofosbuvir with velpatasvir for 12 weeks under the national viral hepatitis programme. How does sofosbuvir act?
1. AInhibits the NS5A protein
2. BInhibits the NS5B RNA polymerase
3. CInhibits viral reverse transcriptase
4. DInhibits the NS3/4A protease
Answer and explanation in LearnFree account
Question 14 · Medium
A 22-year-old man from Bihar has had two generalised seizures. Contrast MRI of the brain shows five viable parenchymal cysts, several with a visible scolex, and mild surrounding oedema. Fundoscopy is normal. The treating team plans: 1. Antiepileptic drugs. 2. Albendazole. 3. Corticosteroids started with the cysticidal drug. 4. Praziquantel added to albendazole because there are more than two cysts. Which parts of the plan are correct?
1. A2, 3 and 4 only
2. B1 and 3 only
3. C1 and 2 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 15 · Medium
A 40-year-old man with HIV and a CD4 count of 30 cells/µL has CMV retinitis and is started on IV ganciclovir. In week 2 his TLC falls to 1,200/µL with an absolute neutrophil count of 500/µL. Which antiviral is the best alternative?
1. AOseltamivir
2. BAcyclovir
3. CFoscarnet
4. DZidovudine
Answer and explanation in LearnFree account
Question 16 · Hard
A 66-year-old man with compensated hepatitis C cirrhosis and atrial fibrillation takes amiodarone, apixaban and pantoprazole. He is started on sofosbuvir-velpatasvir. On day 3 he has a syncopal episode, and his pulse is 34/min with a junctional rhythm on the ECG. Which interaction best explains this?
1. AVelpatasvir with pantoprazole
2. BSofosbuvir with amiodarone
3. CApixaban with amiodarone
4. DVelpatasvir with apixaban
Answer and explanation in LearnFree account
Question 17 · Medium
A 46-year-old woman has been on tenofovir disoproxil fumarate, lamivudine and dolutegravir for 5 years. She now has bone pain and fatigue. Urine shows glucose and protein with a normal blood glucose, serum phosphate is 1.8 mg/dL (reference 2.5-4.5 mg/dL) and creatinine has risen. Which drug is the most likely cause?
1. ALamivudine (cytidine analogue)
2. BDolutegravir (integrase inhibitor)
3. CCotrimoxazole prophylaxis
4. DTenofovir disoproxil fumarate
Answer and explanation in LearnFree account
Question 18 · Medium
A 50-year-old man in the sixth week of the intensive phase of treatment for pulmonary TB has a hot, swollen, painful right great toe. Serum uric acid is 10.5 mg/dL (reference 3.5-7.2 mg/dL). How does the drug most likely responsible raise uric acid?
1. AIt causes volume depletion and haemoconcentration
2. BIts metabolite inhibits renal urate secretion
3. CIt increases purine release by cell lysis
4. DIt inhibits the enzyme xanthine oxidase
Answer and explanation in LearnFree account
Question 19 · Medium
A 30-year-old man with HIV is switched to an abacavir-containing regimen because of kidney disease. In week 2 he develops fever, a rash, vomiting, abdominal pain and breathlessness, which worsen after each dose. Abacavir is stopped. Which test before treatment would have identified his risk?
1. AHLA-B*58:01
2. BHLA-B*15:02
3. CHLA-B*57:01
4. DHLA-B27
Answer and explanation in LearnFree account
Question 20 · Medium
A 27-year-old woman with rifampicin-resistant pulmonary TB is started on an all-oral regimen containing bedaquiline at a district DR-TB centre. A baseline ECG is recorded and repeated during treatment. How does bedaquiline kill Mycobacterium tuberculosis?
1. AInhibits DNA-dependent RNA polymerase
2. BInhibits arabinosyl transferase
3. CInhibits mycolic acid synthesis
4. DInhibits mycobacterial ATP synthase
Answer and explanation in LearnFree account
Question 21 · Medium
A 28-year-old woman at 26 weeks of pregnancy has fever, cough and breathlessness during an influenza A (H1N1) outbreak. SpO2 is 93% on room air. Oral oseltamivir is started before the test result. How does oseltamivir act?
1. ABlocks the M2 channel and prevents uncoating
2. BInhibits cap-dependent endonuclease
3. CInhibits neuraminidase and blocks virus release
4. DCauses lethal mutagenesis of viral RNA
Answer and explanation in LearnFree account
Question 22 · Medium
A 35-year-old man is on oral metronidazole for an amoebic liver abscess. At a wedding he drinks whisky and within minutes develops facial flushing, a throbbing headache, nausea, vomiting and palpitations. What is the usual explanation for this reaction?
1. ASerotonin excess from MAO inhibition
2. BHypoglycaemia from insulin release
3. CAcetaldehyde build-up from blocked aldehyde dehydrogenase
4. DHistamine release from mast cells
Answer and explanation in LearnFree account
Question 23 · Easy
A 45-year-old man with diabetes and heavy alcohol use has had burning and numbness of both feet in a stocking distribution since the second month of treatment for pulmonary TB. Which vitamin, given with his TB drugs, would have prevented this?
1. ACyanocobalamin
2. BFolic acid
3. CThiamine
4. DPyridoxine
Answer and explanation in LearnFree account
Question 24 · Medium
A 24-year-old woman with tuberculous cervical lymphadenitis is about to start first-line TB treatment. She takes a combined oral contraceptive pill and does not want to become pregnant in the next year. What is the best contraceptive advice during her treatment?
1. ASwitch to a progestogen-only pill
2. BA copper IUD or condoms
3. CEmergency pill after each exposure
4. DContinue the same combined pill
Answer and explanation in LearnFree account
Question 25 · Hard
A 32-year-old man with HIV (baseline CD4 60 cells/µL) and drug-sensitive TB lymphadenitis improved during 4 weeks of TB treatment. Two weeks after ART was started he has new fever, enlarging fluctuant cervical nodes and new lung infiltrates. CD4 is now 210 cells/µL and the viral load has fallen sharply. Rifampicin resistance and other infections have been excluded. What is the best management?
1. AStop ART until TB treatment ends
2. BChange to an MDR-TB regimen
3. CStop TB drugs for suspected drug fever
4. DContinue both treatments; add prednisolone
Answer and explanation in LearnFree account

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Anti-TB, antiviral, antifungal and antiparasitic drugs

A 28-year-old man is newly diagnosed with HIV, CD4 count 90 cells/µL. He also has TB meningitis, confirmed by CBNAAT on CSF as rifampicin-sensitive, and started first-line TB treatment with dexamethasone one week ago. He is conscious and improving. When should ART be started?

A 35-year-old man with HIV and cryptococcal meningitis is on IV amphotericin B deoxycholate, oral flucytosine and cotrimoxazole prophylaxis. On day 7 serum potassium is 2.6 mmol/L, magnesium is low and creatinine has risen from 0.8 to 1.6 mg/dL. Which drug is the most likely cause?

A 34-year-old man is newly diagnosed with HIV and drug-sensitive pulmonary TB at an ART centre. He started first-line TB treatment containing rifampicin 10 days ago. ART with tenofovir, lamivudine and dolutegravir (TLD) is now planned. What adjustment is needed?

A 30-year-old man from a village in Jharkhand has had fever with chills for 3 days. The bivalent rapid diagnostic test is positive for Plasmodium falciparum. He is alert, eating and drinking, and has no warning signs of severe malaria. Which treatment is appropriate?

A 45-year-old woman in week 4 of first-line treatment for pulmonary TB has nausea, vomiting and yellow eyes. ALT is 320 U/L (upper limit 40 U/L) and bilirubin 4.2 mg/dL. HBsAg, IgM anti-HAV and IgM anti-HEV are negative, and she does not drink alcohol. What is the most appropriate management?

A 38-year-old man with HIV, started on zidovudine, lamivudine and efavirenz 4 months ago because of kidney disease, comes to the ART centre with fatigue and breathlessness on exertion. Hb is 6.8 g/dL, MCV 112 fL, and serum B12 and folate are normal. Which drug is the most likely cause?

A 19-year-old man from Gujarat has fever with chills every other day, and his blood smear shows Plasmodium vivax. He is started on chloroquine, and primaquine is planned for 14 days. Which test should ideally be done before primaquine is started?

A 60-year-old man in the ICU has a central line, is on parenteral nutrition and has received broad-spectrum antibiotics for 2 weeks. Blood cultures grow Candida glabrata, and IV caspofungin is started. How does caspofungin act?

A 65-year-old man has painful vesicles over the left forehead and the tip of his nose and is started on oral acyclovir for herpes zoster ophthalmicus. What gives acyclovir its selective toxicity for virus-infected cells?

A 32-year-old woman starts treatment for pulmonary TB at a DOTS centre. On day 3 she returns, worried that her urine and tears have turned orange-red and her soft contact lenses are stained. Her eyes are not yellow. What is the most appropriate advice?

A 42-year-old man has chronic hepatitis C with high HCV RNA and compensated liver disease. He is started on sofosbuvir with velpatasvir for 12 weeks under the national viral hepatitis programme. How does sofosbuvir act?

A 40-year-old man with HIV and a CD4 count of 30 cells/µL has CMV retinitis and is started on IV ganciclovir. In week 2 his TLC falls to 1,200/µL with an absolute neutrophil count of 500/µL. Which antiviral is the best alternative?

A 50-year-old man in the sixth week of the intensive phase of treatment for pulmonary TB has a hot, swollen, painful right great toe. Serum uric acid is 10.5 mg/dL (reference 3.5-7.2 mg/dL). How does the drug most likely responsible raise uric acid?

A 30-year-old man with HIV is switched to an abacavir-containing regimen because of kidney disease. In week 2 he develops fever, a rash, vomiting, abdominal pain and breathlessness, which worsen after each dose. Abacavir is stopped. Which test before treatment would have identified his risk?

A 27-year-old woman with rifampicin-resistant pulmonary TB is started on an all-oral regimen containing bedaquiline at a district DR-TB centre. A baseline ECG is recorded and repeated during treatment. How does bedaquiline kill Mycobacterium tuberculosis?

A 28-year-old woman at 26 weeks of pregnancy has fever, cough and breathlessness during an influenza A (H1N1) outbreak. SpO2 is 93% on room air. Oral oseltamivir is started before the test result. How does oseltamivir act?

A 35-year-old man is on oral metronidazole for an amoebic liver abscess. At a wedding he drinks whisky and within minutes develops facial flushing, a throbbing headache, nausea, vomiting and palpitations. What is the usual explanation for this reaction?

A 45-year-old man with diabetes and heavy alcohol use has had burning and numbness of both feet in a stocking distribution since the second month of treatment for pulmonary TB. Which vitamin, given with his TB drugs, would have prevented this?

A 24-year-old woman with tuberculous cervical lymphadenitis is about to start first-line TB treatment. She takes a combined oral contraceptive pill and does not want to become pregnant in the next year. What is the best contraceptive advice during her treatment?