A 40-year-old patient of yours is planning to climb Mt. Everest. Which of the following is considered an important risk factor for highaltitude pulmonary edema?
Answer(s): C
Incidence of high-altitude pulmonary edema is related to the rate of ascent, altitude reached, and degree of exertion. Cold temperature increases pulmonary artery pressure through sympathetic stimulation and is an independent risk factor. Recurrence rate may be as high as 60% in persons with a previous history of highaltitude pulmonary edema. These individuals have reduced ventilatory response to hypoxia and an exaggerated pulmonary pressor response to exercise and hypoxia.
Apreviously healthy 19-year-old woman has a sudden onset of headache, profound myalgias, profuse vomiting, and diarrhea. The woman is near the end of her menstrual period and is using tampons. She appears to be suffering from toxic shock syndrome (TSS). Which of the following is the most likely skin finding?
Answer(s): D
Toxin-producing S. aureus organisms have been implicated in the pathogenesis of TSS and are frequently cultured from the vagina and cervix of affected women. There is no diagnostic laboratory test, and diagnosis is based on the typical clinical findings. Diffuse macular erythroderma (sunburn-like rash) occurs in the first few days of illness, followed by desquamation, usually of the palms and soles 12 weeks later.Fever, hypotension, and multiorgan-system involvement (GI, CNS, muscular, renal, hepatic, hematologic) are also part of the case definition.Platelet counts are usually reduced below 100,000. Disorientation may occur but without such focal neurologic signs as hyperreflexia. Complications include shock, arrhythmias, renal failure, respiratory failure, and coagulopathy. Hypercalcemia is not a part of the picture.
Apreviously healthy 19-year-old woman has a sudden onset of headache, profound myalgias, profuse vomiting, and diarrhea. The woman is near the end of her menstrual period and is using tampons. She appears to be suffering from toxic shock syndrome (TSS). Which of the following is the most likely skin finding?Which of the following is another common finding in TSS and is part of the case definition?
Toxin-producing S. aureus organisms have been implicated in the pathogenesis of TSS and are frequently cultured from the vagina and cervix of affected women. There is no diagnostic laboratory test, and diagnosis is based on the typical clinical findings. Diffuse macular erythroderma (sunburn-like rash) occurs in the first few days of illness, followed by desquamation, usually of the palms and soles 12 weeks later.Fever, hypotension, and multiorgan-system involvement (GI, CNS, muscular, renal, hepatic, hematologic) are also part of the case definition.Platelet counts are usually reduced below 100,000. Disorientation may occur but without such focal neurologic signs as hyperreflexia. Complications include shock, arrhythmias, renal failure, respiratory failure, and coagulopathy. Hypercalcemia is not a part of the picture
A 45-year-old man with HIV is being evaluated in the clinic. His HIV diagnosis was made 6 months ago and he wants to know more about medication treatment options. Which of the following is an indication to initiate HIV medication treatment?
Answer(s): E
Adherence to a drug regimen is critical to prevent antiretroviral drug resistance. Treatment usually should be offered to patients who are symptomatic from their HIV infection. Asymptomatic patients should have antiretroviral therapy offered if their CD4 counts are less than 350 or plasma HIV viral load is greater than 50,000 copies. A high viral load (>100,000 copies) correlates with poor prognosis and an increased likelihood of developing opportunistic infections.
A24-year-old female is infected with HIV from an unprotected sexual exposure. What is the median time for this patient to develop clinical disease if she is not treated?
The median time from initial infection with HIV to the development of clinical disease is 10 years. The rate of disease progression is highly variable and directly correlates with HIV RNA levels. With high levels of HIV RNA, the disease progresses faster. During the asymptomatic period of HIV infection, CD4+ cells decline at an average rate of 50 L per year.Some patients do not progress and show little if any decline in CD4+ counts over time.
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