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Old 10-28-2012
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Arrow Billy Step 1 Questions # 49

A 25-year-old HIV-positive man presents to his primary physician because he has been exposed to herpes. He is concerned because he had a friend with AIDS who developed a fatal disseminated herpes infection and is afraid the same thing might happen to him. The exposure occurred 2 days ago when he shared an ice cream bar with his niece, whom he noticed
afterward had an oral lesion. To his knowledge he has never had an oral lesion. Neither he nor his partner has ever had “cold sores.” Which of the following is the most appropriate approach to this patient?



(A) Admit to hospital for initiation of intravenous anti-herpes simplex virus immunoglobulin therapy
(B) Admit to hospital for intravenous acyclovir therapy
(C) Follow patient closely for development of complications, but it is too late to initiate acyclovir therapy
(D) Prescribe oral acyclovir, fi ve times daily for 7 days and follow closely for clinical disease
(E) Reassure him that he is unlikely to develop severe disease and that he will probably contract herpes simplex virus-1 sooner or later
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Old 10-28-2012
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Since Herpes hasn't showed up yet in this guy, I think we should go with option D and hook him up with Acyclovir. That seems the most appropriate choice to me.
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Is this NBME question?. Anyway, I think D is the answer.

Quote:
Originally Posted by billy View Post
A 25-year-old HIV-positive man presents to his primary physician because he has been exposed to herpes. He is concerned because he had a friend with AIDS who developed a fatal disseminated herpes infection and is afraid the same thing might happen to him. The exposure occurred 2 days ago when he shared an ice cream bar with his niece, whom he noticed
afterward had an oral lesion. To his knowledge he has never had an oral lesion. Neither he nor his partner has ever had “cold sores.” Which of the following is the most appropriate approach to this patient?



(A) Admit to hospital for initiation of intravenous anti-herpes simplex virus immunoglobulin therapy
(B) Admit to hospital for intravenous acyclovir therapy
(C) Follow patient closely for development of complications, but it is too late to initiate acyclovir therapy
(D) Prescribe oral acyclovir, fi ve times daily for 7 days and follow closely for clinical disease
(E) Reassure him that he is unlikely to develop severe disease and that he will probably contract herpes simplex virus-1 sooner or later
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Old 10-28-2012
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i think i did this question already but with valacyclovir option additionally....

anyways...thinking D as answer

thanks
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Old 10-28-2012
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E.............
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Quote:
Originally Posted by venky2600 View Post
i think i did this question already but with valacyclovir option additionally....

anyways...thinking D as answer

thanks
ya i missed E option............so E is the appropriate one...

thanks @greatarablion
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Old 10-28-2012
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(E) Reassure him that he is unlikely to develop severe disease and that he will probably contract herpes simplex virus-1 sooner or later
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Old 10-28-2012
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Correct Answer D is correct

From the history, it is possible that this is the patient’s first exposure to herpes simplex virus (HSV). In patients with HIV, a 7-day course of oral acyclovir has been shown to reduce the duration and morbidity associated with HSV infection, and there may also be a role for acyclovir in prophylaxis if administered soon after exposure.

Answer A is incorrect. This is not an available therapy for HSV type 1 infection.
Answer B is incorrect. If the patient develops severe disease, this is appropriate therapy. However, he is asymptomatic at this time, and this treatment plan may be more harmful (line infection, nosocomial infection) than benefi cial.
Answer C is incorrect. Acyclovir therapy is effective if initiated within 72 hours of infection. This patient is still within the window for initiation
of therapy.
Answer E is incorrect. This would be an inappropriate course of action. This patient is immunosuppressed and is therefore at risk for developing severe disease.
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