doc_clotaire
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A 34-year-old man comes to the office because he has experienced 6 weeks of gradually increasing fevers, dry cough and shortness of breath. Records show he has lost 5.4 kg (12 lb) since his last routine visit 6 months ago. Today, on physical examination, there are several large, nontender, anterior and posterior cervical lymph nodes. His medical history includes infectious mononucleosis, hepatitis B,impetigo, prostatitis and tinea versicolor.
1.- Which of the following factors in his history is most suggestive of pneumonia related to a sexually transmitted disease?
(A) Hepatitis B
(B) Impetigo
(C) Infectious mononucleosis
(D) Prostatitis
(E) Tinea versicolor
2.- What do you think this patient most like have ( diagnosis ) ?
3.- Which of the following is the most appropriate question to ask this patient when inquiring about his sexual orientation?
(A) "Have you been sexually active with men, women, or both?"
(B) "Have you ever had homosexual relations?"
(C) "How many girlfriends have you had?"
(D) "How many times have you had sex with other men?"
(E) "What are your views about homosexuality?"
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| robin082006
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1. A, by exclusion, Hepatitis B is most suitable.
2. Pneumocystis carinii pneumonia
3.(A) ------>"Have you been sexually active with men, women, or both?"
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| mjl1717
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1)prostatitis -answer-d...
2)chlamydiae pneumonia(atypical) from homosexual or prostatitis due to chlamydia
3) Only answer -a is proper communication
*I do not see anything that hints that he has AIDS .
Edited by mjl1717 on 03/02/07 - 11:11 AM
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| lam79m
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1) A: HBV most likely std or parenteral
2) PCP. Dyspnea+lymph node enlargements + fever for some time points in the direction of AIDS. Maybe a lymphoid malignancy could be a cause.
3) A: sounds the best.
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| doc_clotaire
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1.- The correct answer is A
This 34-year-old man’s past medical history includes
multiple prior infections, including mononucleosis, hepatitis B, prostatitis, and tinea
versicolor. Furthermore, he has had a subacute illness with weight loss, fevers, and a
nonproductive cough. The history of hepatitis B and prostatitis in a young man with these
symptoms should always suggest the possibility of HIV infection transmitted through
homosexual activity. Of the listed infections ( impetigo [choice B], infectious
mononucleosis [choice C], prostatitis [choice D]), hepatitis B is the infection most likely
to be transmitted sexually.
2.- PCP related AIDS
3.- The correct answer is A
Although the history is suggestive of HIV, it is not entirely
clear from the history whether the sexually transmitted disease was obtained through
homosexual or heterosexual activity. In a 34-year-old man in this country, HIV is more
often associated with homosexual than heterosexual transmission. However, the most
appropriate phrasing of a question about sexual orientation is the one that asks for a
detailed sexual history in a neutral manner.
Asking about homosexual relations (choice B), the number of girlfriends (choice C), and
how many times he has had sex with other men (choice D) are not the most appropriate
way to inquire about his sexual orientation. It is best to ask a broad, neutral, nonleading
question.
Asking about his views on homosexuality (choice E) is inappropriate and irrelevant.
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