A 43-Year-Old Man Comes to the Clinic Due to Fever

question 1249

Multiple Choice

A 43-year-old man comes to the clinic due to fever, night sweats, fatigue, and progressive skin lesions.  The patient says the skin lesions started as small, reddish/purple papules that gradually enlarged to large nodules.  He has a history of HIV and is not compliant with antiretroviral therapy or prophylactic antimicrobials.  His last CD4 count 3 months ago was 50/mm³.  He has been hospitalized in the past for Pneumocystis pneumonia.  The patient is homeless and primarily lives outdoors but sometimes stays in shelters.  Temperature is 38 C (100.4 F) , blood pressure is 116/70 mm Hg, and pulse is 92/min.  The patient is cachectic.  White plaques are present on his palate.  Hepatosplenomegaly is present.  Skin examination shows several purple, pedunculated lesions on the face and extremities that are friable and bleed easily with palpation.  CT scan of the abdomen reveals hypodense liver lesions that enhance with intravenous contrast.  Which of the following is the most likely cause of this patient's current systemic illness?

• A)Bartonella species
• B)Candida species
• C)Cytomegalovirus
• D)Mycobacterium avium complex
• E)Nocardia species
• F)Pneumocystis jirovecii (formerly P carinii)
• G)Pox virus

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Definitions:

Family Life Cycle

A series of stages through which a family typically progresses, such as marriage, childbirth, upbringing of children, and the eventual departure of adult children from the home.

Evolutionary Theory

A scientific theory proposing that species change over time through a process of natural selection, genetic variation, and reproduction.

Provide Well

The act of adequately supplying what is needed, often used in the context of fulfilling financial or emotional needs in familial or relationship settings.

Socioeconomic Status

A measure of an individual's or family's economic and social position relative to others, based on income, education, and occupation.