For which of the following patients would you recommend prophylaxis against mycobacterium avium-intracellulare?
A30-year old HIV positive male with CD4 count of 20 cells/microliter and a viral load of < 50 copies/mL
B22-year old HIV positive female with CD4 count of 750 cells/microliter and a viral load of 500,000 copies/mL
C45-year old HIV positive female with CD4 count of 250 cells/microliter and a viral load of 100,000 copies/mL
D50-year old HIV positive female with CD4 count of 150 cells/microliter and a viral load of < 50 copies/mL
E36-year old HIV positive male with CD4 count of 75 cells/microliter and an undetectable viral load
You are seeing a patient in clinic who recently started treatment for active tuberculosis. The patient is currently being treated with rifampin, isoniazid, pyrazinamide, and ethambutol. The patient is not used to taking medicines and is very concerned about side effects. Specifically regarding the carbohydrate polymerization inhibiting medication, which of the following is a known side effect?
AVision loss
BParesthesias of the hands and feet
CCutaneous flushing
DArthralgias
EElevated liver enzymes
A 28-year-old woman comes to the physician because of a two-month history of fatigue and low-grade fevers. Over the past 4 weeks, she has had increasing shortness of breath, a productive cough, and a 5.4-kg (11.9-lb) weight loss. Three months ago, the patient returned from a two-month trip to China. The patient appears thin. Her temperature is 37.9°C (100.2°F), pulse is 75/min, and blood pressure is 125/70 mm Hg. Examination shows lymphadenopathy of the anterior and posterior cervical chain. Rales are heard at the left lower lobe of the lung on auscultation. Laboratory studies show a leukocyte count of 11,300/mm3 and an erythrocyte sedimentation rate of 90 mm/h. An x-ray of the chest shows a patchy infiltrate in the left lower lobe and ipsilateral hilar enlargement. Microscopic examination of the sputum reveals acid-fast bacilli; polymerase chain reaction is positive. Sputum cultures are pending. After placing the patient in an airborne infection isolation room, which of the following is the most appropriate next step in management?
AAdminister only isoniazid for 9 months
BAdminister isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for 4 months
CAwait culture results before initiating treatment
DObtain CT scan of the chest
EPerform interferon-γ release assay
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