WBR0709

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Infectious Disease, SubCategory::Infectious Disease
Prompt	[[Prompt::A 28 years old male comes to your office complaining loss of concentration in his work which affected his performance in last 3 weeks. He mentions a recurrent on and off fever for which some medications were prescribed, when he did his routine labs and turned to be normal. He is having a persistent dry cough, recurrent itchy rash over the face and axilla, and loss of 15 pound over the past 3 weeks. He is taking some vitamins to help him maintaining his performance at work. He admits having multiple sexual relations, and when he asked about using condoms he answered” I don’t feel comfortable using condoms”. Which of the following is the best next step in the diagnosis?]]
Answer A	AnswerA::Order Complete blood count
Answer A Explanation	[[AnswerAExp::Incorrect Anemia should be excluded, but HIV infection suspicion should be high in any young patient with non specific symptoms]]
Answer B	AnswerB::Order chest x-ray
Answer B Explanation	[[AnswerBExp::Incorrect Chest x-ray should be done after exclusion o HIV]]
Answer C	AnswerC::Order urine culture
Answer C Explanation	AnswerCExp::No need to order urine culture as there is no urinary symptoms
Answer D	AnswerD::Order HIV test
Answer D Explanation	[[AnswerDExp::Correct HIV infection suspicion should be high in any young patient with non specific symptoms, and the patient should be screened for HIV infection]]
Answer E	AnswerE::Alternate the vitamins with another
Answer E Explanation	[[AnswerEExp::Incorrect Vitamin deficiency is not the cause of his symptoms.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::HIV infection suspicion should be high in any young patient with non specific symptoms, and unintentional l loss of weight. New onset seborrheic dermatitis is commonly seen in HIV infected patients. The patient should be screened for HIV infection, and possible risk factors, which include detailed sexually history and any IV drugs use. Educational Objective: References: ]]
Approved	Approved::No
Keyword	[[WBRKeyword::HIV]]
Linked Question	Linked::
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