A 44-Year-Old Man Comes to the Office Due to Several

question 141

Multiple Choice

A 44-year-old man comes to the office due to several weeks of difficulty walking and frequent falls.  He has had no headache or visual impairment but reports episodes of sharp, stabbing pain in his extremities.  The patient has HIV acquired from unprotected sexual contact and is nonadherent with treatments.  Temperature is 37 C (98.6 F) .  Neurologic examination shows 5/5 motor power in all extremities.  Deep-tendon reflexes are absent at the knee and ankle bilaterally.  Proprioception and vibration sensation are reduced throughout the lower extremities.  He has a wide-based gait and a positive Romberg sign.  Which of the following diagnostic findings is most likely associated with this patient's current symptoms?

• A)Cerebrospinal fluid (CSF) culture growing acid-fast bacilli
• B)CSF PCR positive for herpes virus
• C)Encapsulated yeasts on CSF India ink preparation
• D)Polyomavirus-infected glial cells on brain biopsy
• E)Reactive VDRL tests on CSF samples
• F)Ring-enhancing lesions on brain MRI

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