View source for WBR0702

{{WBRQuestion
|QuestionAuthor={{MM}}
|ExamType=USMLE Step 3
|MainCategory=Community Medical Health Center, Primary Care Office
|SubCategory=Infectious Disease
|MainCategory=Community Medical Health Center, Primary Care Office
|SubCategory=Infectious Disease
|MainCategory=Community Medical Health Center, Primary Care Office
|SubCategory=Infectious Disease
|MainCategory=Community Medical Health Center, Primary Care Office
|MainCategory=Community Medical Health Center, Primary Care Office
|SubCategory=Infectious Disease
|MainCategory=Community Medical Health Center, Primary Care Office
|SubCategory=Infectious Disease
|MainCategory=Community Medical Health Center, Primary Care Office
|SubCategory=Infectious Disease
|MainCategory=Community Medical Health Center, Primary Care Office
|SubCategory=Infectious Disease
|MainCategory=Community Medical Health Center, Primary Care Office
|MainCategory=Community Medical Health Center, Primary Care Office
|SubCategory=Infectious Disease
|Prompt=30 year old female nurse accidentally pricks her finger with a needle used to draw a blood sample from HIV-positive patient.  The patients laboratory testing showed CD4 count of 410/mm3 and HIV load of 12,000copies/mL.  HIV test to the nurse turn to be negative, she has no significant medical history and taking no medications.  Her immunizations are up to date.  What is the best approach to handle this situation?
|Explanation=Exposure to body fluids of HIV-positive patient should be followed within hours by antiretroviral prophylaxis.  Regimen include two nucleoside reverse transcriptase inhibitor (zidovudine and lamivudine ) for four weeks,  some experts suggest adding protease inhibitor (e.g. indinavir ) if viral resistance to the post exposure prophylaxis is suspected
|AnswerA=Four weeks therapy with one nucleoside reverse transcriptase  inhibitor and one protease inhibitor
|AnswerAExp=Incorrect

Therapy with one nucleoside reverse transcriptase inhibitor and one protease is not recommended

|AnswerB=Six month therapy with one nucleoside reverse transcriptase inhibitor and one protease inhibitor
|AnswerBExp=Incorrect

Therapy with one nucleoside reverse transcriptase inhibitor and one protease is not recommended
|AnswerC=Four weeks therapy with two nucleoside reverse transcriptase inhibitor
|AnswerCExp=Correct

Immediate therapy with prophylactic two nucleoside reverse transcriptase inhibitor after exposure and continued for 4 weeks is recommended

|AnswerD=Four month therapy with two nucleoside reverse transcriptase inhibitor
Incorrect

|AnswerDExp=Incorrect

Although the use of two nucleoside reverse transcriptase inhibitor is recommended, the duration should be Four weeks rather than Four months
|AnswerE=No antiretroviral therapy unless she is HIV positive
|AnswerEExp=Incorrect

No action to HIV exposure is not recommended, systemic infection doesn’t occur immediately after inoculation with HIV.  Therefore any health care worker exposed to HIV-positive bodily fluids should use a prophylactic regimen to minimize becoming HIV-positive
|RightAnswer=C
|Approved=No
}}