WBR0708

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Allergy/Immunology, SubCategory::Infectious Disease
Prompt	[[Prompt::30 years old white male come to clinic for new hire routine check-up. He has no significant complain. He admits having multiple sexual partners, not using condoms frequently. He didn’t have HIV test before. His past medical history is insignificant. He doesn’t smoke but drink alcohol regularly. He has no drug or food allergy. His physical examination is insignificant. You ordered HIV and RPR test which turned to be positive. His CD4 is 300 mm3 and RPR titer 1:70. The diagnosis of HIV infected patient with latent syphilis of unknown duration was established. The patient begins his treatment with benzathin penicillin G IM weekly for three weeks. Several hours later, the patient presents to ED with severe headache, muscle pain, fever and rigors. Which of the following could have prevented this condition?]]
Answer A	AnswerA::Careful allergic history taking
Answer A Explanation	[[AnswerAExp::Incorrect Jarich-Herxheimer reaction is not an allergic reaction]]
Answer B	AnswerB::Detailed family history
Answer B Explanation	[[AnswerBExp::Incorrect Jarich-Herxheimer reaction is not an inherited drug allergy]]
Answer C	AnswerC::Nothing could prevent this condition
Answer C Explanation	[[AnswerCExp::Correct No effective prevention is available, the patient should be informed with this possible condition, and advised to contact his clinician in severe cases]]
Answer D	AnswerD::Pre-treatment with antihistamines
Answer D Explanation	[[AnswerDExp::Incorrect Antihistamines has no role in immunological acute febrile reaction]]
Answer E	AnswerE::Assessment of drug sensitivity more accurately
Answer E Explanation	AnswerEExp::Acute febrile reaction is not a sensitivity rather than immunological reaction
Right Answer	RightAnswer::C
Explanation	[[Explanation::Jarich-Herxheimer reaction is an acute febrile reaction develops within 24hours after the initiation of any syphilis treatment. Fever is usually accompanied with headache, malaise, chills, and myalgias. The etiology is not clear. No effective prevention is available. The patient should be informed with this possible condition, and advised to contact his clinician in severe cases. Educational Objective: References: ]]
Approved	Approved::No
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