A 34-Year-Old Man Comes to the Emergency Department Due to 3

question 1478

Multiple Choice

A 34-year-old man comes to the emergency department due to 3 weeks of fever, night sweats, fatigue, cough, and shortness of breath.  He has lost 4.5 kg (10 lb) over this period.  The patient was diagnosed with HIV a year ago but is not taking antiretroviral medication.  His CD4 count was 80/mm³ 3 months ago.  The patient is unemployed and recently moved to Missouri to live with his parents.  He does not use tobacco, alcohol, or illicit drugs.  Temperature is 38.5 C (101.3 F) , blood pressure is 110/66 mm Hg, and pulse is 108/min.  There are small ulcers on the hard palate and multiple enlarged lymph nodes in the cervical and inguinal chains.  Pulmonary examination reveals scattered lung crackles.  The patient's abdomen is soft and nontender, but there is prominent hepatosplenomegaly.  Laboratory studies show pancytopenia and elevated aminotransferase levels.  Chest x-ray reveals bilateral reticulonodular opacities with hilar lymphadenopathy.
Which of the following is the best next step in management of this patient?

• A)Bronchoalveolar lavage for Pneumocystis infection
• B)Fungal blood cultures
• C)Lymph node biopsy
• D)Treponema pallidum enzyme immunoassay
• E)Urine Histoplasma antigen

---

Definitions:

Defective Products

Products that are not safe for their intended use due to design, manufacturing, or labeling flaws.

Standing

Refers to the legal right of an individual or entity to initiate a lawsuit, predicated on having a sufficient connection to and harm from the law or action challenged.

Summary Judgment

A judicial decision made without a full trial, based on the premise that the material facts of the case are undisputed and require only a legal interpretation to resolve.

Motion for Judgment

A motion for judgment is a legal request asking the court to issue a judgment in the filer's favor before a full trial is conducted.