A 46-Year-Old Man Comes to the Office for Follow-Up

question 634

Multiple Choice

A 46-year-old man comes to the office for follow-up.  The patient was diagnosed with HIV 10 years ago and has had episodes of pneumocystis pneumonia, cryptococcal meningitis, and oropharyngeal candidiasis.  He has been treated with several different antiretroviral combinations due to drug resistance from medication nonadherence.  Over the past year, he notes a sensation of numbness and pinpricks in his feet, which has now progressed proximally up his lower legs.  Vital signs are within normal limits.  There is loss of sensation to touch, pain, and temperature over the distal legs and feet bilaterally.  Motor strength is intact, but ankle jerk reflex is decreased bilaterally.  Cranial nerve examination is normal, and there are no signs of meningeal irritation.  Blood cell counts, liver and renal function tests, and fasting plasma glucose are within normal limits.  CD4 count is 180/mm³.  In addition to counseling about the importance of adherence to antiretroviral therapy, which of the following is the most appropriate treatment for this patient's current symptoms?

• A)Acetaminophen-hydrocodone
• B)Gabapentin
• C)Lamotrigine
• D)Magnesium supplement
• E)Prednisone

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Definitions:

T Statistic

A value used in statistical hypothesis testing to determine if there is a significant difference between two sample means.

Body Fat

The percentage of a person's body mass that is made up of fat tissue versus lean body mass.

ANOVA Table

A table used to summarize the sources of variability in an analysis of variance, which helps determine whether there are significant differences between group means.

NFL

The National Football League, a professional American football league consisting of 32 teams divided between the National Football Conference (NFC) and the American Football Conference (AFC).