Case Study 1 M.C. is a 29-year-old white male who
Case Study 1 M.C. is a 29-year-old white male who tested positive for HIV 21â„2 years ago. He visits the HIV clinic at regular 2- to 3-month intervals for routine follow-up, most recently six weeks ago. He has been stable on antiretroviral treatment consisting of tenofovir, emtricitabine, and lopinavir-ritonavir for the last 11 months. Prior to that, the patient had developed drug resistance to his initial combination regimen of zidovudine, lamivudine, and efavirenz. He presents today complaining of moderate dyspnea, a persistent and non-productive cough, and fatigue. Social history: 1. Homosexual, admitted to engaging in both unprotected anal and oral intercourse with multiple partners since age 22, one partner died 8 months ago from AIDS-related complications 2. Smoked 3 ppd for 10 years before quitting 2 years ago. 3. Past history of alcohol abuse, cocaine sniffing, and IVDU Physical examination 1. Thin, slightly anxious, acutely ill-appearing, young white male with tachypnea 2. Cervical, axillary, and inguinal lymphadenopathies. 3. Bibasilar crackles with auscultation Image transcription text 9 Months Ago 6 Months Ago 3 Months Ago This Visit GENERAL Weight (1bs) 167 167 162 155 Blood pressure 125/72 120/65 (mm Hg) 120/72 130/87 HEM… Show more 1. Identify and provide reasoning for this patient’s two most significant risk factors for developing HIV disease. 2. Identify the two most specific clinical signs in the physical examination that support a diagnosis of pneumonia.? Explain your answer. 3. Relative to his previous two visits to the HIV clinic, what do the patient’s HIV markers indicate at this time? Which AIDS-defining clinical manifestations or complications has this patient developed? Please explain. 4. Direct HIV infection of renal cells may result in clinical manifestations of kidney disease. Do laboratory tests indicate that HIV has affected kidney function? Please explain. 5. Based on the CDC HIV Classification System, what is the current clinical category (or stage of HIV infection) for this patient? Case Study 2 E.O. is an 8-year-old girl with a history of asthma and allergy to bee stings. She has been brought to the clinic complaining of a throat infection. Her health care provider prescribes a course of penicillin to manage her current infection and cautions her parents to watch her closely for a reaction. Discussion Questions 1. What type of reaction is the health care provider concerned about and why? 2. Explain the role of IgE and mast cells in type I hypersensitivity reactions. 3. Can penicillin cause delayed hypersensitivity? Please explain. 4. What would you tell E.O.’s parents to look for when they are assessing for a reaction? 5. What would you suggest the parents do if a reaction does occur?
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