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  #1  
Old 08-01-2013
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Listening Peds question #3

You are called by a PCPC while you were playing golf (you are a pediatric infectious disease fellow), to consult on a patient admitted to the hospital a couple of days ago. The patient is a 7 month old Caucasian boy with poor weight gain for the past 3 months, he has not gained a single pound in the hospital despite seemingly adequate nutrition. You take a detailed diet history from his foster mother (his biological mother is a leg-opener and her whereabouts are unknown). PE reveals an active alert infant with a strong suck reflex who appears wasted. You note generalized lymphadenopathy with hepatomegaly. You also find a severe case of oral candidiasis that has been resistant to treatment. Which of the following is the most important/appropriate next step in the evaluation of this child?

A. Increase kcal/kg by 30%.
B. Send stool for fecal fat.
C. Perform a rectal manometry.
D. Draw blood cultures and start empiric antibiotics.
E. Order HIV PCR.
F. Order HIV ELISA.
G. Order HIV reverse Transcriptase levels.

This following question I'm making it up just because I can.

Explain what would've been the best action/preventive method in order to avoid this disease?
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  #2  
Old 08-01-2013
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Ans : A

lack of nutrition leading to immuno deficiency .
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  #3  
Old 08-01-2013
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ok I would have to go with G....to get the reverse transcriptase for HIV.....it supports the candidiasis and the wasting syndrome could be from the Mycobacterium avium Intracellulare which does present with symptoms he shows and it supports the candidiasis since his cd 4 levels must be really low. the best prevention would be Haart which has to include Zidovudine from first triemester if possible but if the mother is good you can start it from 2nd.

its a llong shot lol i hope i am right
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ok I would have to go with G....to get the reverse transcriptase for HIV.....it supports the candidiasis and the wasting syndrome could be from the Mycobacterium avium Intracellulare which does present with symptoms he shows and it supports the candidiasis since his cd 4 levels must be really low. the best prevention would be Haart which has to include Zidovudine from first triemester if possible but if the mother is good you can start it from 2nd.

its a llong shot lol i hope i am right
You are close, it is indeed testing for HIV, however it is not reverse transcriptase, Will give you a second chance! think carefully!
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Old 08-01-2013
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Originally Posted by Hitman View Post
Ans : A

lack of nutrition leading to immuno deficiency .
Gave the clue with the Mom's profession! (leg opener is a nice way of saying she likes working out.... As a PROSTITUTE)!

Last edited by XpaezX; 08-01-2013 at 03:26 PM.
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Old 08-01-2013
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Gave the clue with the Mom's profession! (leg opener is a nice way of saying she likes working out.... As a PROSTITUTE)!
PCR....since ELisa wont be a good test for an infant....so you need to detect the virus itself......aaaah man you got me with that reverse transcriptase lol
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Old 08-01-2013
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PCR....since ELisa wont be a good test for an infant....so you need to detect the virus itself......aaaah man you got me with that reverse transcriptase lol
Indeed my friend! Reverse transcriptase is sometimes used to monitor RESPONSE TO TREATMENT! not to diagnose HIV!

You dont do ELISA because Anti/HIV maternal antibodies can remain for up to 3 years! thats why you go with PCR for viral load!

You wanted challenging questions? I deliver!

The patient indeed suffers from HIV, the explanation again was perfectly described by you, this child's mom worked as a prostitute and thats probably the reason this patient has HIV, by the looks of it he is pretty darn screwed, he has AIDS not HIV because he is symptomatic.

The best way to help him would be to start HAART and start to kill the fastidious bugs that are causing this clinical scenario.

What would be the DOC for the candidiasis and for MAV? now that we are discussing the topic?
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Old 08-01-2013
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Indeed my friend! Reverse transcriptase is sometimes used to monitor RESPONSE TO TREATMENT! not to diagnose HIV!

You dont do ELISA because Anti/HIV maternal antibodies can remain for up to 3 years! thats why you go with PCR for viral load!

You wanted challenging questions? I deliver!

The patient indeed suffers from HIV, the explanation again was perfectly described by you, this child's mom worked as a prostitute and thats probably the reason this patient has HIV, by the looks of it he is pretty darn screwed, he has AIDS not HIV because he is symptomatic.

The best way to help him would be to start HAART and start to kill the fastidious bugs that are causing this clinical scenario.

What would be the DOC for the candidiasis and for MAV? now that we are discussing the topic?
i took a shot in the dark hahaa...that was the only logical answer.....
for candidiasis we can use fluconazole and for the MAI (clarithromycin and Ethambutol) and Azithro for prophylaxis for MAI untill his CD4 recovers...that goes for the fluconazole too since it would prophylax against the pcp untill his cd4 is over 200
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FYI we can still use HAART because that whole idea of Immune reconstitution syn is bogus...yes it does happens but the symptoms occurs from Haart killing the pathogens and the patients shows the physical symptoms. SO even if a reaction occurs we still have to continue haart
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i took a shot in the dark hahaa...that was the only logical answer.....
for candidiasis we can use fluconazole and for the MAI (clarithromycin and Ethambutol) and Azithro for prophylaxis for MAI untill his CD4 recovers...that goes for the fluconazole too since it would prophylax against the pcp untill his cd4 is over 200
Excellent case closed!
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Old 08-03-2013
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Excellent case closed!
Love the fact that you wrote leg-opener instead of prostitute haha
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Love the fact that you wrote leg-opener instead of prostitute haha
Yup didnt want to be that direct haha.

Will post more questions later
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