A 38-Year-Old Woman Comes to the Emergency Department with a 2-Week

question 865

Multiple Choice

A 38-year-old woman comes to the emergency department with a 2-week history of worsening headaches and low-grade fever.  She has no weakness or sensory loss.  The patient has lost a significant amount of weight over the last 6 months.  Her temperature is 38.1 C (100.5 F) , blood pressure is 115/70 mm Hg, pulse is 100/min, and respirations are 14/min.  BMI is 18.7 kg/m².  The patient has neck stiffness and cervical lymphadenopathy.  Oropharyngeal examination shows thrush.  The neurologic examination is nonfocal, and fundoscopy is within normal limits.  CT scan of the head without contrast is normal.  Lumbar puncture is performed and results of cerebrospinal fluid analysis are as follows: Cerebrospinal fluid fungal stain shows encapsulated yeast.  Which of the following is the most appropriate next step in management of this patient?

• A)Amphotericin plus flucytosine
• B)Griseofulvin
• C)HIV testing and antiretroviral therapy
• D)Itraconazole
• E)Sulfadiazine-pyrimethamine

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Definitions:

Cartilage

A flexible, rubbery connective tissue found in various parts of the body, providing structure and reducing friction between bones.

Synovial Joint

Capsule-enclosed joint at which cartilage-covered ends of bones are separated by a fluid-filled space.

Muscle Fiber

The cylindrical, multinucleate cells that make up skeletal muscles, responsible for contracting to produce movement.

Myofibril

Within a muscle fiber, a threadlike array of proteins organized as a series of sarcomeres (contractile units).