Friday, January 25, 2013

HIV Patient With Confusion and Disorientation

Clinical Vignette: A 42-year-old HIV-seropositive man presents to Casualty with a two-week history global headache. His partner
says that he has become increasingly confused and disorientated. The patient's latest CD4 count, taken three weeks ago, was 50 cells/mm3. He had chosen not to take antiretroviral therapy, but was taking co-trimoxazole as prophylaxis against Pneumocystis carinii pneumonia.
On examination he had mild weakness of his left arm and leg in all muscle groups and a right homonymous hemianopia. Fundoscopy was normal with no evidence of papilloedema.
A CT scan of his brain showed several areas of low attenuation in both cerebral hemispheres, but there was no enhancement with contrast and no mass effect. What is the most likely diagnosis?

  1. Cerebral lymphoma
  2. Cerebral toxoplasmosis
  3. HIV encephalopathy
  4. Neurosyphilis
  5. Progressive multifocal leukoencephalopathy
Thursday, January 24, 2013

Female with papules and vesicles

Clinical Vignette: A 40-year-old female presents with a six month history of pruritic papules, vesicles and excoriations on the elbows, knees, buttocks and scalp. Her GP has prescribed topical betamethasone therapy which has been unhelpful. What is the most likely diagnosis?

  1. Atopic dermatitis (Eczema)
  2. Dermatitis herpetiformis
  3. Hennoch-Schonlein purpura
  4. Psoriasis
  5. Scabies

Diabetic male with Erectile dysfunction and decreased libido

Clinical Vignette: A 36-year-old male with insulin-dependent diabetes mellitus of three years duration presented with decreased libido and erectile dysfunction since diagnosis. No abnormalities were noted on genital examination. Investigations revealed:

  • plasma testosterone 6.0 nmol/L (9 - 35)
  • plasma follicle stimulating hormone 1.0 u/L (1-8)

Which of the following investigations is most appropriate next step?
  1. autonomic function testing
  2. Doppler studies of penile artery
  3. Nerve conduction studies
  4. Serum ferritin
  5. Serum prolactin