A 50-Year-Old Man Is Brought to the Emergency Department Due

question 161

Multiple Choice

A 50-year-old man is brought to the emergency department due to fever, malaise, confusion, and worsening headache for the last 8 days.  He has a history of advanced AIDS and is noncompliant with antiretroviral therapy.  His most recent CD4 lymphocyte count a month ago was 29/mm³.  His other medical problems include hypertension and chronic hepatitis C infection.
The patient's temperature is 38.8 C (101.8 F) , blood pressure is 110/70 mm Hg, pulse is 94/min, and respirations are 16/min.  He is disoriented to place and time and has a left-sided visual field deficit.  The remainder of the examination is unremarkable.
CT scan of the head without contrast is normal.  A lumbar puncture yields the following results:

India ink preparation of the cerebrospinal fluid shows encapsulated yeast.  The patient is started on amphotericin B.
In addition to antifungal therapy, which of the following is the most effective strategy to improve this patient's outcome?

• A)Acetazolamide
• B)Corticosteroids
• C)Immediate antiretroviral therapy
• D)Mannitol
• E)Serial lumbar punctures

---

Definitions:

Excessive Spending

The act of spending funds beyond what is considered reasonable or sustainable, often leading to financial imbalances.

Current Account

A component of a country's balance of payments that includes the trade balance, net income from abroad, and net current transfers, reflecting the difference between a nation's savings and its investment.

Billion

A number equal to a thousand million (1,000,000,000) in the short scale, or a million million (1,000,000,000,000) in the long scale, depending on the country.

Balance Of Trade

The difference in value between a country's imports and exports over a period of time.