NBME 24 HIV (NBME Answers)

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nbme24/Block 2/Question#16 (reveal difficulty score)
A 28-year-old man with chronic hepatitis C ...
HIV 🔍 / 📺 / 🌳 / 📖
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submitted by ∗aneurysmclip(209)

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pretty straightforward question but another thing you couldd do is figure out his lymphocyte count 5%x2000 = 100 which would line up with a low Cd4 count however you divide it

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tyrionwill Yes agree! Lymphocyte count is so low, which suggest HIV. +

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+8 upvote downvote
submitted by ∗m-ice(370)

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The patient seems to have an infection due to their elevated temperature and abnormal chest X-ray. However, their leukocyte count is low. In addition, the patient has hepatitis C, which is often associated with similar transmission routes to HIV, like intravenous drug use.

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sajaqua1 Not only is their WBC count low, it is not uniform. If we assume a minimum normal WBC count of 5000 cells/mL^3, and a regular range of ~60% neutrophils, then normally a person should have ~3,000 neutrophils/mL^3. This patient has a total of 2000 cells/mL^3, with 1,800 neutrophils/mL^3. Their lymphocytes and macrophages have been whiped out. This is best accounted for by HIV. +47

koftawesa CXR sounded like pneumocystis jiroveci which HIV patients are at high risk for- infections like these are usually the way HIV patients find out they have HIV +1

wasting of muscle and subcutaneous adipose tissue = cachexia or wasting syndrome , none of options is causing cachexia besides HIV

+7/- usmlecrasherss(27)

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+2 upvote downvote
submitted by ∗abhishek021196(119)

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According to FA 2020 Pg175, AIDS diagnosis: ≤ 200 CD4+ cells/mm3 (normal: 500–1500 cells/mm3). This patient has 5% lymphocytes out of 2000 overall = 100 cells = AIDS.

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