An HIV +ve Patient

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An HIV +ve Patient

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9 Posts

Delusional
Forum Elite

Topics: 41
Posts: 226

06/16/03 - 08:52 PM

28 year old HIV +ve patient with a CD4 count of 350 3 months ago and known to be a close contact of a Tuberculosis patient presents to the ER with symptoms od dyspnea, non-productive cough with fever and chills.

CXR reveals a B/L interstitial infiltrate with no Hilar Lymphadeopathy or cavitation or nodularity.....the Apices are clear....

A PPD was done and it was negative....

1- next best step.....
2- best diagnostic test

:wink:

allant
Forum Newbie

Topics: 1
Posts: 6

06/17/03 - 02:25 PM

1.check PaO2 & A-a gradient
2.bronchoscopy & bronchoalveolar lavage

:?:

Delusional
Forum Elite

Topics: 41
Posts: 226

06/17/03 - 08:21 PM

Correct.......

but now don't u think u should have already had an idea about what the paitent might have in order for your next step to be a step of Treatment...

so ...bronchoscopy and Bronchoalveolar lavage is correct as the best step for diagnosis.....as this patient has a non productive cough there is no way to retrieve pulmonary secretions other than thru the BAL

But the the next step in management is ABG and Aa gradient but i am not stessing too much on the degree of hypoxemia here and regardless of that.....let me give u choices......

1....Trim/sulfamethoxazole
2...Pentamidine
3...Gancyclovir
4...INH/Rifam/Pyrazin/ethambutol
5...Amphotereicin B

what is ur choice......

smitha
Forum Elite

Topics: 53
Posts: 236

06/29/03 - 12:36 PM

Is it Trimethoprim/sulpha???????? Coz Pentamidine is also given in this case (PCP)...........but as far as i remember, DOC is TMP/SULPHA.
:?:

Delusional
Forum Elite

Topics: 41
Posts: 226

06/29/03 - 12:40 PM

No Satya sorry....
Let me ask u a question

what do u think the risk of a patient who had a recent history of contact of Tb to acquire Tb? High or low
and
what do u think the risk of a patient who has HIV to contract Tb? high or low

smitha
Forum Elite

Topics: 53
Posts: 236

06/29/03 - 12:49 PM

Ok, as far as i know, it's 10% life time risk for normal people exposed to TB & 10%/year risk for HIV positive patients.
So, wat wud u like to say then...................3rd one is the choice??????
:?: :?: :?:

smitha
Forum Elite

Topics: 53
Posts: 236

06/29/03 - 12:51 PM

sorry, i mean the 4th one shud be the choice??????????

Delusional
Forum Elite

Topics: 41
Posts: 226

06/29/03 - 12:56 PM

yes ...correct

this is a case of Tuberculosis unless proved otherwise....

non-productive cough with fever and chills.

CXR reveals a B/L interstitial infiltrate with no Hilar Lymphadeopathy or cavitation or nodularity.....the Apices are clear....

A PPD was done and it was negative....

It is true all these are not consistent with Tb but you should tell me why they are not........even though this is most likely a case of TB ( as u have mentioned ...very high risk for these patients to contact TB esp if they were close contacts)

usmledoctor1
Forum Junior

Topics: 4
Posts: 77

08/02/04 - 06:38 AM

do such hair line judgement type ques r asked in usmle 2

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