1. 61) A 23-year-old woman complains of headaches and arthralgias for the past 3
days. She presents to urgent care because of a painful rash on her face that
has progressed into multiple vesicles. This rash is characterized by
erythematous macules with dark purple centers with multiple vesicles in
different stages. On physical exam there is also mucosal edema within the
oral cavity. She recently completed an antibiotic course for a urinary tract
infection. What is the most likely diagnosis?
A) Erythema multiforme
B) Staphylcoccal scalded skin syndrome
C) Stevens–Johnson syndrome
D) Toxic epidermal necrolysis
Answer C. Stevens-Johnson syndrome is an immune-complex–mediated
hypersensitivity complex that typically involves the skin and the mucous
membranes. After one to three weeks of exposure to the causative agent, a
prodrome of fever, malaise, headache, cough, and conjunctivitis develops.
Skin lesions appear one to three days after this prodrome. The lesions
initially appear as erythematous macules with dark purpuric centers, then
form atypical target lesions with central dusky purpura or a central bulla,
with surrounding macular erythema. Mucosal involvement occurs in
almost all affected patients. By definition, Stevens-Johnson syndrome
affects less than 10% of the body surface area. Approximately 50% of cases
of Stevens-Johnson syndrome are drug induced. Common causative agents
include sulfa drugs, antiepileptic drugs, antibiotics, and nonsteroidal anti-
inflammatory drugs. Steven-Johnson syndrome is a clinical diagnosis. The
causative drug and any unnecessary medications should be discontinued.
Aggressive management should include fluid resuscitation, nutritional
supplementation, and wound care. Antibiotics should be used only if there
is evidence of infection. Intravenous immune globulin has been
incorporated into some treatment protocols. Complications include
hypotension, renal failure, corneal ulcerations, anterior uveitis, erosive
vulvovaginitis, respiratory failure, seizures, and coma.

2. Staphylococcal scalded skin syndrome (B) most commonly occurs in
infants and in young children, faint, orange-red, macular erythema with
cutaneous tenderness. Periorificial and flexural accentuation may be
observed. Characteristic tissue paper–like wrinkling of the epidermis is
followed by the appearance of large, flaccid bullae in the axillae, in the
groin, and around the body orifices. Toxic epidermal necrolysis (D) is a
potentially life-threatening dermatologic disorder characterized by
widespread erythema, necrosis, and bullous detachment of the epidermis
and mucous membranes, resulting in exfoliation. By definition, toxic
epidermal necrolysis affects more than 30 percent of the body surface area.
Erythema multiforme minor (A) represents a localized eruption of the
skin with minimal or no mucosal involvement. The papules evolve into
pathognomonic target lesions that appear within a 72-hour period and
begin on the extremities. Lesions remain in a fixed location for at least 7
days and then begin to heal.
OSF
Q) What is the definition of Stevens-Johnson/toxic epidermis necrolysis?
A) When the body surface area involved in 15-30%.
Ref:
Sandy, Natasha, MD, University of Texas Health Science Center School of
Medicine, San Antonio, Texas Am Fam Physician. 2010 Oct 1;82(7):773-780.
62) A 32-year-old woman complains of a band-like pressure around her forehead
that radiates down to the back of her neck. These headaches occur twice a
week on average and last for approximately 1 hour in duration. Her

3. neurological exam is within normal limits and she has no other associated
symptoms. What is the best initial abortive treatment?
A) Amitriptyline
B) Caffeine
C) Ibuprofen
D) Promethazine
Answer C. Tension-type headaches cause pain that is mild or moderately
intense and is described as tightness, pressure, or a dull ache. The pain is
usually experienced as a band extending bilaterally back from the forehead
across the sides of the head to the occiput. Patients often report that this
tension radiates from the occiput to the posterior neck muscles. In its most
extensive form, the pain distribution is “cape like,” radiating along the medial
and lateral trapezius muscles covering the shoulders. Tension-type
headaches can last from 30 minutes to several days and can be continuous in
severe cases. In addition to its characteristic distribution and intermittent
nature, the history obtained from patients with tension-type headache
discloses an absence of signs of any serious underlying condition. Patients
with tension-type headache do not typically report any visual disturbance,
fever, stiff neck or recent trauma. Treatment goals for patients with tension-
type headache should include recommending effective over the counter
analgesic agents and discovering and ameliorating any circumstances that
may be triggering the headaches. Research confirms that NSAIDs, such as
Ibuprofen, and acetaminophen are effective in reducing headache
symptoms. Patients with chronic tension-type headache should limit their
use of analgesics to two times weekly to prevent the development of chronic
daily headache. Repeated use of analgesics, especially ones containing
caffeine or butalbital, can lead to “rebound” headaches as each dose wears off
and patients then take another round of medication. Common features of
chronic daily headache associated with frequent analgesic use are early
morning awakening with headache, poor appetite, nausea, restlessness,
irritability, memory or concentration problems, and depression. If the patient
requires analgesic medication more frequently, adjunctive headache
medications can be initiated. Smoking cessation is an important issue to
address in patients with chronic tension-type headache. The number of
cigarettes smoked has been “significantly related” to the headache index
score and to the number of days with headache each week.

4. Analgesics can be augmented with a sedating antihistamine, such as
promethazine (D) and diphenhydramine or an antiemetic, such as
metoclopramide and prochlorperazine. If this regimen is inadequate, the
patient can try acetaminophen or aspirin combined with caffeine (B) and
butalbital. A wide variety of prophylactic agents have been researched in the
management of chronic tension-type headache. Amitriptyline (A) is the
most researched of the prophylactic agents for chronic tension-type
headache. It is typically used in doses of 10 to 75 mg, one to two hours before
bedtime to minimize grogginess on awakening.
OSF
Q) What is the first-line abortive therapy for moderate to severe migraine
headaches?
A) Triptans.
Ref:
Boride, Jonathon, M.D. Medical College of Wisconsin, Milwaukee, Wisconsin
Am Fam Physician. 2002 Sep 1;66(5):797-805.
63) A 24-year old primigravida delivers a healthy full-term baby boy. After the
third stage of labor there is significant bright red blood coming from the
cervix. On physical exam there are no vaginal or cervical lacerations and no
retained products are visualized. On fundal massage the uterus is boggy.
What pharmacological agent should be started immediately?
A) Carboprost tromethamine
B) Methylergonovine
C) Misoprostol
D) Oxytocin
Answer D. Postpartum hemorrhage (PPH) is the leading cause of maternal
mortality. Postpartum hemorrhage, defined as blood loss of more than 500

5. mL following vaginal delivery or more than 1000 mL following cesarean
delivery, occurs in up to 18% of births. Risk factors for postpartum
hemorrhage include a prolonged third stage of labor, multiple delivery,
episiotomy, fetal macrosomia, and history of postpartum hemorrhage.
However, postpartum hemorrhage also occurs in women with no risk factors,
so physicians must be prepared to manage this condition at every delivery.
The diagnosis of postpartum hemorrhage begins with recognition of
excessive bleeding and methodic examination to determine its cause. The
“Four Ts” mnemonic (Tone, Trauma, Tissue, and Thrombin) can be used to
detect specific causes. Uterine atony is the most common cause of
postpartum hemorrhage. Because hemostasis associated with placental
separation depends on myometrial contraction, atony is treated initially by
bimanual uterine compression and massage, followed by drugs that promote
uterine contraction. Uterotonic agents include oxytocin, ergot alkaloids, and
prostaglandins. Oxytocin stimulates the upper segment of the myometrium
to contract rhythmically, which constricts spiral arteries and decreases blood
flow through the uterus. Oxytocin is an effective first-line treatment for
postpartum hemorrhage; 10 international units (IU) should be injected
intramuscularly, or 20 IU in 1 L of saline may be infused at a rate of 250 mL
per hour. As much as 500 mL can be infused over 10 minutes without
complications
Other second and third-line medications are given in the event of postpartum
hemorrhage after the initiation of Oxytocin. Methylergonovine (B) is an
alkaloid that cause generalized smooth muscle contraction in which the
upper and lower segments of the uterus contract tetanically. A typical dose of
methylergonovine, 0.2 mg administered intramuscularly, may be repeated as
required at intervals of two to four hours. Because ergot alkaloid agents raise
blood pressure, they are contraindicated in women with preclampsia or
hypertension. Prostaglandins enhance uterine contractility and cause
vasoconstriction. The prostaglandins most commonly used are carboprost
and misoprostol. Carboprost (A) can be administered intramyometrially or
intramuscularly in a dose of 0.25 mg; this dose can be repeated every 15
minutes for a total dose of 2 mg. Hypersensitivity is the only absolute

6. contraindication, but carboprost should be used with caution in patients with
asthma or hypertension. Misoprostol (D) is another prostaglandin that
increases uterine tone and decreases postpartum bleeding. Misoprostol is
effective in the treatment of postpartum hemorrhage, but side effects may
limit its use.
OSF
Q) What is the definitive treatment for postpartum hemorrhage in women
with severe intractable bleeding?
A) Hysterectomy.
Ref:
Etches, Duncan, M.D., M.CL.SC., University of British Columbia Faculty of
Medicine, Vancouver, British Columbia Am Fam
Physician. 2007 Mar 15;75(6):875-882.
64) A 26-year old woman presents to urgent care with a fever of 101.4°F, dysuria
and nausea for the past 24 hours. On physical exam, exquisite pain is elicited
on palpation of the right flank. She does not appear toxic. She is able to eat
and drink, despite her nausea. Her pregnancy test is negative and her
urinalysis is pending. What is the best management and treatment for this
patient?
A) Inpatient management with intravenous ceftriaxone
B) Inpatient management with intravenous vancomycin
C) Outpatient management with oral ciprofloxacin
D) Outpatient management with oral nitrofurantoin
Answer C. Acute pyelonephritis is a common bacterial infection of the renal
pelvis and kidney most often seen in young adult women. Most patients have
fever, although it may be absent early in the illness. Flank pain is nearly
universal, and its absence should raise suspicion of an alternative diagnosis.
Risk factors for acute pyelonephritis in nonpregnant women include sexual
intercourse three or more times per week during the previous 30 days,
urinary tract infections in the previous 12 months, diabetes, stress
incontinence in the previous 30 days, a new sex partner in the previous year,
recent spermicide use, and a history of urinary tract infections in the
patient's mother. A positive urinalysis confirms the diagnosis in patients with
a compatible history and physical examination. Urine culture should be
obtained in all patients to guide antibiotic therapy if the patient does not
respond to initial empiric antibiotic regimens. Escherichia coli is the most
common pathogen in acute pyelonephritis, and in the past decade, there has
been an increasing rate of E. coli resistance to extended-spectrum beta-
lactam antibiotics. Uncomplicated acute pyelonephritis typically occurs in
healthy, young women without structural or functional urinary tract
abnormalities and without relevant comorbidities. Complicated acute
pyelonephritis occurs in patients with a structurally or functionally abnormal

7. genitourinary tract, or a predisposing medical condition. Most cases of
uncomplicated acute pyelonephritis can be managed in the outpatient
setting. However, patients who appear ill may have severe pyelonephritis or
a complication of acute pyelonephritis and should be considered for
hospitalization and further evaluation. For uncomplicated pyelonephritis,
outpatient treatment with fluoroquinolones is the preferred empiric
antimicrobial class in communities where the local prevalence of resistance
of community-acquired E. coli is 10 percent or less. If the prevalence of
fluoroquinolone resistance among relevant organisms does not exceed 10
percent, patients not requiring hospitalization can be treated with oral
ciprofloxacin (500 mg twice per day for seven days), or a once-daily oral
fluoroquinolone, such as ciprofloxacin (1,000 mg, extended-release, for seven
days) or levofloxacin (750 mg for five days). If the resistance rate exceeds 10
percent, an initial intravenous dose of ceftriaxone or gentamicin should be
given, followed by an oral fluoroquinolone regimen.
Outpatient management with oral nitrofurantoin(D) is not recommended
for pyelonephritis, however it is commonly used for treatment in acute
cystitis. For women with complicated acute pyelonephritis, inpatient
therapy with intravenous ceftriaxone (A) is recommended. Other options
for inpatient management with intravenous antibiotics include a
fluoroquinolone, an aminoglycoside, an extended-spectrum penicillin, or a
carbapenem. Inpatient treatment with intravenous vancomycin (B) is not
recommended because this antibiotic does not have gram-negative coverage.
OSF
Q) What is the management and treatment for pyelonephritis in pregnancy?
A) Inpatient management with an intravenous second- or third-generation
cephalosporin.
Ref:
Johnson, James, MD, University of Minnesota, Minneapolis, Minnesota Am

8. Fam Physician. 2011 Sep 1;84(5):519-526.
65) A 46-year-old man with papulopustular rosacea sees you for follow-up. You
have been treating his condition with topical azelaic acid, and although his
condition is improved he is not satisfied with the results. You suggest adding
which one of the following oral medications?
A) Clindamycin
B) Doxycycline
C) Erythromycin
D) Metronidazole
Answer B. Rosacea is a common condition characterized by symptoms of
facial flushing and a spectrum of clinical signs, including erythema,
telangiectasia, coarseness of skin, and an inflammatory papulopustular
eruption resembling acne. In most patients, the central area of the face is
affected, such as the nose, forehead, chin, and perioral areas. The diagnosis of
rosacea is made clinically. Patients with rosacea should avoid sun exposure
and use a broad-spectrum sunscreen daily that has a sun protection factor of
at least 15. Avoidance of common triggers such as hot baths, alcohol, spicy
foods, emotional stress is important to prevent outbreaks. Topical regimens
are first-line therapies for mild papulopustular rosacea because there is less
risk of adverse events, drug interactions, and antibiotic resistance. Topical
metronidazole is generally well tolerated with few local skin adverse
reactions, and it is the recommended topical therapy for rosacea. Topical
azelaic acid, sulfacetamide products, and topical acne medications are also
commonly used. Oral tetracyclines, most commonly doxycycline, tetracycline,
and minocycline have been used to treat papulopustular rosacea for more
than four decades. Doxycycline is the only drug approved by the FDA to
specifically treat papulopustular rosacea. Three to four weeks of therapy
with a tetracycline is required before substantial improvement occurs;
typical duration of therapy ranges from six to 12 weeks.

9. Macroclides such as erythromycin (C), clarithromycin and azithromycin
have been studied in patients with rosacea, but study quality is poor. Oral
metronidazole (D) is a problematic option for patients with rosacea
because of rare adverse effects such as neuropathy, seizures and its
disulfiram-like properties. Clindamycin (A) is not used to treat roasacea.
OSF
Q) What is the only herbal therapy studied in clinical trials to treat rosacea?
A) Licorice.
Ref:
May D, Kelsberg G, Safranek S: What is the most effective treatment for acne
rosacea? J Fam Pract 2011;60(2):108a-100c.
66) A previously healthy 16-year old boy presents to your office after having a
syncopal episode at the start of track practice. An ECG reveals a QTc of 520
ms. This is confirmed on a subsequent ECG. This finding is associated with
which one of the following rhythm abnormalities?
A) Paroxysmal supraventricular tachycardia
B) Polymorphic ventricular tachycardia
C) Sinus arrest
D) Third degree atrioventricular block
Answer B. Patients with repeated ECGs showing a QTc interval > 480 ms with
a syncopal episode, or > 500 ms in the absence of symptoms, are diagnosed
with long QT syndrome if no secondary cause such as medication use is

10. present. In addition to a prolonged QT interval, which occurs in some but not
all persons with long QT syndrome. Prolong QT interval is associated with
polymorphic ventricular tachycardia, including torsades de pointes, and
sudden cardiac death. Most cardiac events are precipitated by vigorous
exercise or emotional stress, but they also can occur during sleep. Long QT
syndrome is usually diagnosed after a person has a cardiac event such as
syncope or cardiac arrest. In some situations, this condition is diagnosed
after a family member suddenly dies. It may be treated with beta-blockers
and implanted cardioverter defibrillators. Patients with long QT
syndrome should avoid participation in competitive sports, strenuous
exercise, and stress-related emotions. Epinephrine adrenaline for local
anesthesia and asthma medication should be avoided in patients with long
QT syndrome. Other medications that should be avoided include certain
antibiotics, antifungals, antihistamines, antiarrythmics and psychotropic
medications which prolong the QT interval.

11. Third-degree atrioventricular block (D) results from various pathologic
states causing infiltration, fibrosis, or loss of connection in portions of the
healthy conduction system. Third-degree atrioventricular block can be either
congenital or acquired. Paroxysmal supraventricular tachycardia (A) is a
narrow-complex tachycardia that has a regular, rapid rhythm and is
triggered by a reentry mechanism. This may be induced by premature atrial
or ventricular ectopic beats. Other triggers include hyperthyroidism and
stimulants, including caffeine, drugs, and alcohol. Paroxysmal
supraventricular tachycardia is observed not only in healthy individuals; it is
also common in patients with previous myocardial infarction, mitral valve

12. prolapse, rheumatic heart disease, pericarditis, pneumonia, chronic lung
disease, and current alcohol intoxication. Sinoatrial arrest is when the
sinoatrial node of the heart transiently ceases to generate the electrical
impulses that normally stimulate the myocardial tissues to contract. It is
defined as lasting from 2.0 seconds to several minutes. None of the above are
associated with long QT syndrome.
OSF
Q) Which electrolyte abnormalities can cause long QT syndrome?
A) Hypokalemia and hypomagnesemia.
Ref:
Longo DL, Fauci AS, Kasper DL, et al (eds): Harrison’s Principles of Internal
Medicine, ed 18. McGraw-Hill, 2012, pp 1897-1900.
67) A 61-year-old woman presents to your office with a sudden painless loss of
vision in her right eye. Her past medical history includes both hypertension
and type 2 diabetes mellitus. Which one of the following would make you
suspect retinal vein occlusion as the cause of her sudden visual loss?
A) An afferent pupillary defect in the contralateral eye
B) Macular drusen on funduscopic examination
C) Right eye scleral injection
D) Tortuous retinal veins on funduscopic examination
Answer D. Central retinal vein occlusion (CRVO) is a common vascular
disorder of the retina and one of the most common causes of vision loss
worldwide. Specifically, it is the second most common cause of blindness
from retinal vascular disease after diabetic retinopathy. The signs of retinal
vein occlusion typically include sudden painless loss of vision, distortion of
vision or dense central scotoma. In some cases, this loss of vision is subtle in
character, with intermittent episodes of blurred vision. In other cases, it may
be sudden and dramatic. The nonischemic type is often the more subtle of the
two, while the ischemic type is prone to the more acute clinical
presentations. Tortuous and dilated retinal veins are the most common
finding on funduscopic examination. Diabetes mellitus and hypertension
are both risk factors for retinal vein occlusion, increasing the likelihood in
this patient.

13. Patients also often have multiple macula drusen (B) commonly known as
cotton-wool spots, although these are not specific to retinal vein occlusion.
Eye redness (C) is not typical and should cause the clinician to suspect an
alternate diagnosis. An afferent pupillary defect (A) often occurs on the
ipsilateral side.
OSF
Q) What are two complications of retinal vein occlusion?
A) Macular edema and neovascularization.
Ref:
Tran KT, Qualm AS, Shannon MA: Retinal changes and visual impairment. Am
Fam Physician 2010;81(1):73.
68) A 58-year-old man with diabetes mellitus and hypertension presents with a
6-month history of generalized pruritus. He reports that he scratches
frequently. On examination his skin is dry and scaly. He has multiple linear
excoriations and thickened skin on his forearms, legs, and neck.
Which one of the following is the most likely cause of his pruritus?
A) Contact dermatitis
B) Chronic urticaria

14. C) Lichen simplex chronicus
D) Scabies
Answer C. This patient has lichen simplex chronicus, consisting of
lichenified plaques and excoriations that result from excessive scratching.
On physical exam, one or more slightly erythematous, scaly, well-
demarcated, lichenified, firm, rough plaques with exaggerated skin lines are
noted. Atopic dermatitis results in a higher probability of developing lichen
simplex chronicus. Psychological factors appear to play a role in the
development or exacerbation of lichen simplex chronicus. Anxiety has been
reported to be more prevalent in patients with lichen simplex chronicus.
Insect bites, scars, postherpetic zoster, xerosis, venous insufficiency and
asteatotic eczema are common factors. An elevated serum immunoglobulin E
level occasionally supports the diagnosis of an underlying atopic diathesis.
Perform potassium hydroxide examination and fungal cultures to exclude
tinea cruris or candidiasis in patients with genital lichen simplex chronicus.
Treatment is aimed at reducing pruritus and minimizing existing lesions
because rubbing and scratching cause lichen simplex chronicus. Location,
lesion morphology, and extent of the lesions influence treatment. For
example, a thick psoriasiform plaque of lichen simplex chronicus on a limb is
commonly treated with a highly potent topical corticosteroid or intralesional
corticosteroids, whereas vulvar lesions are more commonly treated with a
mild topical corticosteroid or a topical calcineurin inhibitor. Widespread
lesions are more likely to require systemic treatment or total body
phototherapy.
Contact dermatitis (A) is usually associated with direct skin exposure to an
allergen or irritant and is typically localized to the area of exposure. Chronic
urticaria (B) causes a typical circumscribed, raised, erythematous lesion

15. with central pallor. Scabies (D) lesions are small, erythematous papules that
are frequently excoriated.
OSF
Q) What common nueuromuscular blockade can be used to treat severe
lichen simplex chronicus?
A) Botulism toxin injections.
Ref:
Moses S: Pruritus. Am Fam Physician 2003;68(6):1135-1142. 2) Habif TP:
Clinical Dermatology: A Color Guide to Diagnosis and Therapy, ed 5. Mosby
Elsevier, 2010, pp 115-118.
69) A 21-year old woman sees you because of a depressed mood since the birth
of her son 2 months ago. She is breastfeeding, and her baby is doing well. She
denies any suicidal or homicidal ideation and has never had thoughts about
hurting the baby. She has a history of depression 2 years ago that was
associated with starting college. She began taking sertraline , changed her
schedule, and spent more time exercising. Within 6 months her depression
resolved and she stopped the medication. She reports this current
depression feels worse than her previous depression. Which one of the
following would be the most appropriate medication for this patient?
A) Amitriptyline
B) Diazepam
C) Phenytoin
D) Sertraline
Answer D. Selective serotonin reuptake inhibitors such as sertraline (D) are
the most commonly used medications for postpartum depression. They have
fewer side effects and are considered safer than tricyclic antidepressants,
especially in depressed women who may be at increased risk for medication
overdose. In one study, infant serum levels of sertraline and paroxetine were
undetectable. It is also recommended that a woman with postpartum
depression be started on a medication that she had taken previously with a
good response, unless there is evidence of potential harm to her infant.
Tricyclic antidepressants such as amitriptyline (A) are excreted into breast
milk and there is some concern regarding potential toxicity to the newborn.
Phenytoin (C) and diazepam (B) are not antidepressants. Phenytoin and
diazepam are Category D for use in pregnant women. Diazepam is potentially
toxic to infants and can accumulate in breastfed infants, and it is not
recommended for lactating women.
OSF

16. Q) What is the strongest risk factor for post partum depression?
A) Postpartum depression in a previous pregnancy.
Ref:
ACOG Committee on Practice Bulletins—Obstetrics: ACOG Practice Bulletin:
Clinical management guidelines for obstetrician-gynecologists number 92,
April 2008 (replaces practice bulletin number 87, November 2007). Use of
psychiatric medications during pregnancy and lactation. Obstet Gynecol
2008;111(4):1001-1020.
70) A 25-year old man presents to your office after recently being diagnosed with
HIV infection at the health department. You obtain blood work and note that
his CD4+ count is 180. This patient should receive prophylaxis against which
one of the following opportunistic infections?
A) Histoplasma capsulatum
B) Mycobacterium avium-intracellulare complex
C) Pneumocystis jirovecci
D) Toxoplasma gondii
Answer C. Patients with HIV infection and severe immunodeficiency are at
risk for certain opportunistic infections. Susceptibility to opportunistic
infections can be measured by CD4+ T lymphocyte counts. Patients with a
CD4+ count < 200 should receive trimethoprim/sulfamethoxazole for
prevention of Pneumocystis jirovecci pneumonia (PCP pneumonia).
Pneumocystis jiroveci pneumonia remains relatively common in patients with
HIV infection, and may be the presenting manifestation of HIV in patients
who have not yet been diagnosed. Patients with P. jiroveci pneumonia
classically present with fever, progressive exertional dyspnea, and
nonproductive cough. Although there are a wide variety of radiologic
findings, chest radiography typically shows bilateral interstitial infiltrates.

17. Toxoplasma-seropositive patients who have a CD4+ T-lymphocyte count of
less than 100 should be administered prophylaxis against Toxoplasma
gondii (D) encephalitis. The daily double-strength tablet of
trimethoprim/sulfamethoxazole is recommended, as the preferred regimen
for Pneumocystis prophylaxis appears to be effective against toxoplasmic
encephalitis as well and is therefore recommended. Adults and adolescents
who have HIV infection should receive chemoprophylaxis against
disseminated Mycobacterium avium-complex (B) disease if they have a
CD4+ T-lymphocyte count of less than 50.Preferred prophylaxis is
clarithromycin or azithromycin.. Prophylaxis with itraconazole may be
considered for Histoplasma capsulatum (A) in patients with CD4+ T-
lymphocyte counts less than 100 who are at especially high risk because of
occupational exposure or who live in a community with a hyperendemic rate
of histoplasmosis (10 or more cases per 100 patient-years).
OSF
Q) What is the treatment for the opportunistic infection, Cryptococcus?
A) Amphotericen B combined with flucytosine.
Ref:
Goldman L, Schafer AI (eds): Goldman’s Cecil Medicine, ed 24. Elsevier
Saunders, 2011, pp 2190-2194.