HIV and testing----------q1

Prep for USMLE Forum

» Log in | Register

Forum

Step 1

Match

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

HIV and testing----------q1

Author

14 Posts

Aashi
Forum Moderator
avatar

Topics: 112
Posts: 968

01/10/08 - 09:48 AM

A 27-year-old HIV-positive man comes to the clinic for a periodic health maintenance examination. He contracted the disease 5 years ago from a former partner. He has been followed in the community health clinic since that time. He has no other medical history and takes only diazepam orally for anxiety. His last visit was 11 months ago. His temperature is 37.0 C (98.6 F), blood pressure is 140/85 mm Hg, pulse is 78/min, and respirations are 12/min. He has clear lung fields bilaterally, his skin is free of rashes or excoriations, and his abdomen is soft and nontender. Blood work drawn a few weeks ago reveals a CD4 count of 98 cells/mm3 and a hematocrit of 34% with an MCV of 95 fl. His last tuberculin skin test was 3 months ago and was read as 4mm and flat. In addition to initiating vitamin B12 and folate therapy for his patient, the most appropriate intervention at this time is

A. antibiotic prophylaxis for PCP pneumonia

B. antibiotic prophylaxis for tuberculosis

C. a skin test for tuberculosis

D. treatment for active tuberculosis infection

E. none is indicated based upon his CD4 count at this time

___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."

sprint123
Forum Guru

Topics: 129
Posts: 870

01/10/08 - 10:23 AM

Ab prophylaxis for PCP for patients with CD4 < 200

mildus
Forum Guru

Topics: 19
Posts: 614

01/10/08 - 11:32 AM

prophylaxis for Pneumocystis Carinii Pneumonia since CD4 < 200/mm3

arlete
Intern in 2009!!!!!
avatar

Topics: 30
Posts: 2,223

01/10/08 - 11:44 AM

A

Should we start for MAC as well? confused

___________________
When men make the rules, God decides the exceptions.

milestogo
Forum Newbie

Topics: 3
Posts: 33

01/10/08 - 12:20 PM

starting pcp prophylaxis seems to be most appropriate

mildus
Forum Guru

Topics: 19
Posts: 614

01/10/08 - 01:30 PM

As far as I remember profylaxis for MAC is initiated when CD4 count is lower than 50/mm3, correct me if I am wrong

Edited by mildus on 01/10/08 - 01:36 PM

cool doctor
Forum Junior
avatar

Topics: 1
Posts: 226

01/10/08 - 02:53 PM

Ivonne
Forum Guru
avatar

Topics: 54
Posts: 1,443

01/10/08 - 03:37 PM

A

For MAC if <50 cells/mm3 with azithromycin

___________________
If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)

kpmle2
Forum Elite

Topics: 29
Posts: 292

01/10/08 - 03:45 PM

A. antibiotic prophylaxis for PCP pneumonia

dr.wad
Forum Senior
avatar

Topics: 3
Posts: 335

01/10/08 - 03:54 PM

#10

A

-MAC prphylaxis is started when CD4 is less than 75/mm3.

-when CD4 is less than 50/mm3 ...start cytomegalovirus prophylaxis.

-tuberculin test is cinsidered positive in HIV pt if > 5 mm.

-prphylaxis for TB is given when tuberculin test is positive.

Ivonne
Forum Guru
avatar

Topics: 54
Posts: 1,443

01/10/08 - 04:42 PM

#11

dr.wad wrote:
A

-MAC prphylaxis is started when CD4 is less than 75/mm3.

-when CD4 is less than 50/mm3 ...start cytomegalovirus prophylaxis.

-tuberculin test is cinsidered positive in HIV pt if > 5 mm.

-prphylaxis for TB is given when tuberculin test is positive.

Could you tell us the source of the first two statements, according to UW:

MAC prophylaxis is started when CD4 is < 50 cells/microL
Gancyclovir may be effective for CMV prophylaxis when CD4< 50 but it is not currently recommended for this purpose. Is it?????

___________________
If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)

dr.wad
Forum Senior
avatar

Topics: 3
Posts: 335

01/10/08 - 04:57 PM

#12

Could you tell us the source of the first two statements, according to UW:

MAC prophylaxis is started when CD4 is < 50 cells/microL
Gancyclovir may be effective for CMV prophylaxis when CD4< 50 but it is not currently recommended for this purpose. Is it?????

[/quote]

source is CURRENET medical dx and tx (2005 )

i know that kaplan is different but i guess current is more accurate.

Aashi
Forum Moderator
avatar

Topics: 112
Posts: 968

01/10/08 - 08:16 PM

#13

The correct answer is A.

Opportunistic infections occur in people with HIV and define many of the components of the clinical syndrome known as AIDS. They are caused by a wide variety of pathogens and all have the common etiology that the host is susceptible due to the immune destruction brought on by the HIV virus. Prognosis depends on the type of infection and often, even with appropriate therapy, morbidity and mortality is high. There are means to prevent or reduce the likelihood of developing these infections. For this patient, his CD4 count of less than 200 cells/mm3 indicates that he should begin antibiotic prophylaxis, usually with TMP/SMX, for PCP pneumonia.

Starting antibiotic prophylaxis for tuberculosis (choice B) is not routine practice except in persons with a PPD-positive skin test, which this patient does not have.

Since the patient was tested for tuberculosis within the last year, and there is no evidence that he is anergic, there is no indication to test him again at this time (choice C).

The patient does not have active tuberculosis infection (choice D). Even if his PPD test were positive, active infection requires documentation of the organism in sputum by PCR or acid-fast staining.
Any patient with a CD4 count of less than 200 cells/mm3 should be considered for prophylaxis therapy for at least PCP pneumonia and toxoplasmosis (choice E).

___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."

arlete
Intern in 2009!!!!!
avatar

Topics: 30
Posts: 2,223

01/11/08 - 11:07 AM

#14

Thank you, guys... smiling face

___________________
When men make the rules, God decides the exceptions.

You don't have permission to post.