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  #1  
Old 12-31-2016
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Default Weird question on nbme :/

42 year old man, comes to the ED with 10 day history of progressive fever, shortness of breath, and non productive cough. 20 kg weight loss during past 2 years, Immigrated to the USA from the Ivory Coast 4 years ago. Temp is 38 degree Celsius, respiration 32/min. Lungs clear to auscultation. Chest Xray shows diffuse interstitial infiltrate- silver stain of specimen shows P. jiroveci. Treatment with high dose prednisone and TMP/SMX is started. Workup for HIV is done:

HIV ELISA +
HIV western blot +
CD4+ Tcell count 22/mm3
Plasma HIV viral load <50 copies/mL

WHat explains these lab results:
a. infection with HIV2
b. Infection with HTLV1
c. infection with HTLV2
d. Infection with simian immune deficiency virus
e. Lack of infection with any HIV strain


If any one wants to discuss NBME 17 please inbox. Need help fast.
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  #2  
Old 12-31-2016
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isn't it A?
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  #3  
Old 01-02-2017
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Default Weird q on NBME

- I go for A too.
HIV-2 is less virulent thus an lowers CD4+ count not as much as HIV1.

- Well, not SIV because it's a big family name of retroviruses (HIV in humans, SIVagm and SIVmnd in monkeys etc). So i won't go for this choice. It's a generalisation. Since we are talking of human here, it limits us to HIV.
Well if there were viral infecttions like Herpes simplex virus that causes genital Herpes characterised by blisters and low cd4+ count too, we might get confused here.
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  #4  
Old 01-02-2017
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Default Weird q on NBME

- I go for A too.
HIV-2 is less virulent thus: CD4+ count not as low as in HIV-1INFECTION.

- Well, not SIV because it's a big family name of retroviruses (HIV in humans, SIVagm and SIVmnd in monkeys etc). So i won't go for this choice. It's a generalisation. Since we are talking of human here, it limits us to HIV.
Well if there were viral infecttions like Herpes simplex virus that causes genital Herpes characterised by blisters and low cd4+ count too, we might get confused here.
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  #5  
Old 01-02-2017
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Quote:
Originally Posted by radhika2210 View Post
42 year old man, comes to the ED with 10 day history of progressive fever, shortness of breath, and non productive cough. 20 kg weight loss during past 2 years, Immigrated to the USA from the Ivory Coast 4 years ago. Temp is 38 degree Celsius, respiration 32/min. Lungs clear to auscultation. Chest Xray shows diffuse interstitial infiltrate- silver stain of specimen shows P. jiroveci. Treatment with high dose prednisone and TMP/SMX is started. Workup for HIV is done:

HIV ELISA +
HIV western blot +
CD4+ Tcell count 22/mm3
Plasma HIV viral load <50 copies/mL

WHat explains these lab results:
a. infection with HIV2
b. Infection with HTLV1
c. infection with HTLV2
d. Infection with simian immune deficiency virus
e. Lack of infection with any HIV strain


If any one wants to discuss NBME 17 please inbox. Need help fast.
If there any antiretroviral mentioned that definetly clarify which type of HIV easily. Becasue prednison and TMP-SMX are to prevent further activities of cd8+ cells on cd4+ (immunosuppresant drug) and for a PCP respectively.
Well, Plasma HIV load data is quite the help here.
Hope this helps.
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