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|QuestionAuthor={{MM}}
|QuestionAuthor={{MM}}
|ExamType=USMLE Step 3
|ExamType=USMLE Step 3
|MainCategory=Primary Care Office
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|MainCategory=Primary Care Office
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|MainCategory=Primary Care Office
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|MainCategory=Primary Care Office
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|MainCategory=Primary Care Office
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|MainCategory=Primary Care Office
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Infectious Disease
|SubCategory=Infectious Disease
|Prompt=27 years old female comes to your office complaining of low grade fever, malaise, and dry cough, recurrent itchy rash over her face and axilla, and loss of 20 pound over the past 3 weeks.  She admits that she has been under a lot of stress recently, as she was working in two jobs at one time to support herself.  Which of the following should be obtained in details to help reach a diagnosis?
|Prompt=A 28 years old male comes to your office complaining loss of concentration in his work which affected his performance in last 3 weeks.  He mentions a recurrent on and off fever that needed some medications recently, but having a persistent dry cough, recurrent itchy rash over the face and axilla, and loss of 20 pound over the past 3 weeks.  He is taking some vitamins to help him maintaining his performance at work.  He admits having multiple sexual relations, and when he asked about using condoms he answered” I don’t feel comfortable using condoms”.  Which of the following is the best next step in the diagnosis?
|Explanation=HIV infection suspicion should be high in any young patient with non specific symptoms, and unintentional l loss of weight.  New onset seborrheic dermatitis is commonly seen in HIV infected patients.  The patient should be screened for HIV infection risk factors, which include detailed sexually history and any IV drugs use.
|Explanation=HIV infection suspicion should be high in any young patient with non specific symptoms, and unintentional l loss of weight.  New onset seborrheic dermatitis is commonly seen in HIV infected patients.  The patient should be screened for HIV infection, and possible risk factors, which include detailed sexually history and any IV drugs use.
|AnswerA=Family history
|AnswerA=Order Complete blood count
|AnswerAExp=Incorrect
|AnswerAExp=Incorrect  
Family history is not important as sexual history in suspected cases of HIV infection
Anemia should be excluded, but HIV infection suspicion should be high in any young patient with non specific symptoms


|AnswerB=Occupational  history
|AnswerB=Order chest x-ray
|AnswerBExp=Incorrect
|AnswerBExp=Incorrect
Occupational history will not help in diagnosis of HIV
Chest x-ray should be done after exclusion o HIV


|AnswerC=Sexual history
|AnswerC=Order urine culture
|AnswerCExp=Correct
|AnswerCExp=No need to order urine culture as there is no urinary symptoms
Detailed sexual history should be obtained in all young patient complain of vague symptoms and loss of weight


|AnswerD=None of the above
|AnswerDExp=Incorrect
Sexual history should be obtained in HIV suspected cases


|AnswerE=All of the above
|AnswerD=Order HIV test
|AnswerDExp=Correct
HIV infection suspicion should be high in any young patient with non specific symptoms, and the patient should be screened for HIV infection
 
|AnswerE=Alternate the vitamins with another
|AnswerEExp=Incorrect
|AnswerEExp=Incorrect
In HIV suspected cases, Detailed sexual history should be obtained in all young patient complain of vague symptoms and loss of weight
Vitamin deficiency is not the cause of his symptoms.
 


|RightAnswer=C
|RightAnswer=D
|WBRKeyword=[[HIV]]
|Approved=No
|Approved=No
}}
}}

Revision as of 17:51, 31 October 2013

 
Author [[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type ExamType::USMLE Step 3
Main Category
Sub Category SubCategory::Infectious Disease
Prompt [[Prompt::A 28 years old male comes to your office complaining loss of concentration in his work which affected his performance in last 3 weeks. He mentions a recurrent on and off fever that needed some medications recently, but having a persistent dry cough, recurrent itchy rash over the face and axilla, and loss of 20 pound over the past 3 weeks. He is taking some vitamins to help him maintaining his performance at work. He admits having multiple sexual relations, and when he asked about using condoms he answered” I don’t feel comfortable using condoms”. Which of the following is the best next step in the diagnosis?]]
Answer A AnswerA::Order Complete blood count
Answer A Explanation [[AnswerAExp::Incorrect

Anemia should be excluded, but HIV infection suspicion should be high in any young patient with non specific symptoms]]

Answer B AnswerB::Order chest x-ray
Answer B Explanation [[AnswerBExp::Incorrect

Chest x-ray should be done after exclusion o HIV]]

Answer C AnswerC::Order urine culture
Answer C Explanation AnswerCExp::No need to order urine culture as there is no urinary symptoms
Answer D AnswerD::Order HIV test
Answer D Explanation [[AnswerDExp::Correct

HIV infection suspicion should be high in any young patient with non specific symptoms, and the patient should be screened for HIV infection]]

Answer E AnswerE::Alternate the vitamins with another
Answer E Explanation [[AnswerEExp::Incorrect

Vitamin deficiency is not the cause of his symptoms.]]

Right Answer RightAnswer::D
Explanation [[Explanation::HIV infection suspicion should be high in any young patient with non specific symptoms, and unintentional l loss of weight. New onset seborrheic dermatitis is commonly seen in HIV infected patients. The patient should be screened for HIV infection, and possible risk factors, which include detailed sexually history and any IV drugs use.

Educational Objective:
References: ]]

Approved Approved::No
Keyword [[WBRKeyword::HIV]]
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Order in Linked Questions LinkedOrder::