A 26-year-old man comes to the physician for a follow-up examination. He was diagnosed with HIV infection 2 weeks ago. His CD4+ T-lymphocyte count is 162/mm3 (N ≥ 500). An interferon-gamma release assay is negative. Prophylactic treatment against which of the following pathogens is most appropriate at this time?
ACytomegalovirus
BToxoplasma gondii
CMycobacterium tuberculosis
DAspergillus fumigatus
EPneumocystis jirovecii
A 45-year-old HIV-positive male presents to his primary care physician complaining of decreased libido. He reports that he has been unable to maintain an erection for the past two weeks. He has never encountered this problem before. He was hospitalized four weeks ago for cryptococcal meningitis and has been on long-term antifungal therapy since then. His CD4 count is 400 cells/mm^3 and viral load is 5,000 copies/ml. He was previously non-compliant with HAART but since his recent infection, he has been more consistent with its use. His past medical history is also notable for hypertension, major depressive disorder, and alcohol abuse. He takes lisinopril and sertraline. His temperature is 98.6°F (37°C), blood pressure is 120/85 mmHg, pulse is 80/min, and respirations are 18/min. The physician advises the patient that side effects like decreased libido may manifest due to a drug with which of the following mechanisms of action?
AInhibition of beta-glucan synthesis
BFormation of pores in cell membrane
CInhibition of ergosterol synthesis
DDisruption of microtubule formation
EInhibition of pyrimidine synthesis
A 69-year-old man with metastatic colon cancer is brought to the emergency department because of shortness of breath, fever, chills, and a productive cough with streaks of blood for the past 5 days. He has a history of emphysema. The patient does not have abdominal pain or headache. He receives chemotherapy with 5-fluorouracil, leucovorin, and oxaliplatin every 6 weeks; his last cycle was 3 weeks ago. His temperature is 38.3°C (101°F), pulse is 112/min, and blood pressure is 100/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 83%. A few scattered inspiratory crackles are heard over the right lung. His mucous membranes are dry. Cardiac examination is normal. Laboratory studies show: Hemoglobin 9.3 mg/dL Leukocyte count 700/mm3 Segmented neutrophils 68% Lymphocytes 25% Eosinophils 4% Monocytes 3% Platelet count 104,000/mm3 Serum Glucose 75 mg/dL Urea nitrogen 41 mg/dL Creatinine 2.1 mg/dL Galactomannan antigen Positive Which of the following is the most appropriate initial pharmacotherapy?
ACeftriaxone and azithromycin
BRifampin, isoniazid, pyrazinamide, and ethambutol
CCeftazidime and levofloxacin
DPiperacillin-tazobactam
EVoriconazole
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