New one next!

Prep for USMLE Forum

» Log in | Register

Forum

Step 1

Match

Prep4USMLE Forum » USMLE Step 2 CK Forum » Internal Medicine Forum

New one next!

Author

12 Posts

SA
Forum Elite

Topics: 21
Posts: 193

01/28/05 - 01:27 PM

A 39 year male come to your office with his ELIZA report which is showing positive for HIV. On history he told you that he use to take iv drugs but now stop it for last one years. He is living with her girl friend for last 5 year and she is the only sexual partner. He has broken with one before and that is all the sexual contact he had.
On examination you did not find any abnormality. Western blot was adviced cofirmed HIV positive on futher investigation CD4 400 viral load is 30000. What will you do next?
1. Call her gf about her positive test
2. Start HAART
3. Chest Radiograph
4. PPD test
5. CT or MRI brain
6. nothing above just follow up

___________________
Wish best of luck to all users

sanz
Forum Elite

Topics: 14
Posts: 154

01/28/05 - 02:50 PM

4. PPD skin testing.

He should be encouraged to tell his gf abt his Dx...

Thnx for the qs smiling face

Hamidi
Forum Guru

Topics: 46
Posts: 471

01/28/05 - 02:51 PM

2.stat HAART.
Criteria to start HAART is eithe CD4 <500 and/or Viral load>20,000
correct me if I am wrong

helenawkd
Forum Newbie

Topics: 0
Posts: 10

01/28/05 - 02:53 PM

I am sorry, what is PPD skin testing?

sanz
Forum Elite

Topics: 14
Posts: 154

01/28/05 - 02:58 PM

PPD skin testing to determine the pt's tuberculosis status.

I think if the pt is asymptomatic, we dont start HAART, unless the CD4 ct <350 and viral load >55,000...

ELM
Forum Guru

Topics: 28
Posts: 936

01/28/05 - 03:30 PM

Sanz is correct, he is not ready yet to recieve any antiretrovirals, but his CD 4 is 400 which is in the rick range for TB infections....so he needs PPD....if induration is above 5mm----> do CXR to rule out active TB, if CXR is positive -----> full TB Tx, if CXR is negative and PPD is positive ---> start INH with B6 profilacticly for 9 months. If everything is negative he is golden for now.
But his gf has to be informed about all this too......so which one we have to pick??? I hate this kind of dilemma. I will have to pick PPD anyhow.

___________________
ELM

SA
Forum Elite

Topics: 21
Posts: 193

01/28/05 - 03:36 PM

I thing the aids syndrom will start tell itself on patient if CD4 is less then 500 so what about treating him?
yes gf is a distracter but a good distracter? what you say?

___________________
Wish best of luck to all users

ELM
Forum Guru

Topics: 28
Posts: 936

01/28/05 - 05:06 PM

CD4 count below 200 in HIV positive patient----> considered to have AIDS. Anitvirals starts when CD4 count <350, or viral load by PCR-RNA >55.000.

___________________
ELM

SA
Forum Elite

Topics: 21
Posts: 193

01/28/05 - 08:16 PM

Blue print says that antiviral should start when CD4 count <500 as it improve the quilty of life and also prolong the life of patient. :?:

___________________
Wish best of luck to all users

Veer-Zaara
Forum Elite

Topics: 16
Posts: 268

01/28/05 - 11:13 PM

#10

I think the answer is HAART.Before just calling up the GF you must discuss with the patient and ideally let him tell the GF about his situation and you give the moral support.

I'm not sure when HAART is commenced but I think it depends on the viral load and also CD count.I was under the impression it was commenced when CD counts fell below 1000!Looks like I'm wrong.

Hamidi
Forum Guru

Topics: 46
Posts: 471

01/28/05 - 11:54 PM

#11

Infact there is a confusion here.Kaplan and Ceicil says CD4<350 and viral load >55000(kaplan) and >30000(ceicl),but Dr Fisher insists in highlight (kaplan )lecture that no matter what anybody say it is CD4 <500 and VL>20000 for USMLE.I don't know wich one to beleive.Anybody has any thing to add to it????

Veer-Zaara
Forum Elite

Topics: 16
Posts: 268

01/29/05 - 02:07 AM

#12

I would say believe the book then.Thanks for researching Hamidi.

You don't have permission to post.