May 25th-2, 2021

Question 1

50M, ?HIV, MSM 1/52 ago, HIV positive partner 5ya, 15py smoking, PEP? 5 risk factors

Answer 1

• anal receptive
• no condom usage
• not on PrEP?
• having other STIs
• uncircumcised
• concomitant illicit substance
• high number sexual partners

Question 2

50M, ?HIV, MSM 1/52 ago, HIV positive partner 5ya, 15py smoking, PEP? 6 points of discussion

Answer 2

• will unlikely benefit from PEP >72hours
• always use barrier protection
• consideration of Pre-exposure prophylaxis if he tests negative
• HIV testing today and in 6-12 weeks
• testing for other STIs, syphilis
• regular 3 month testing

Question 3

50M, HIV, poor compliance with antivirals, 15year later, 2/52 hx of dry cough and fever, 02 98% on RA, 4ddx

a,e,i,j, l,o

Answer 3

• pneumocystis jirovecii pneumonia
• viral pneumonia
• karposi sarcoma
• lymphoma
• lung cancer

Question 4

50M, HIV, poor compliance with antivirals, 15year later, 2/52 hx of dry cough and fever, 02 98% on RA, pneumocystis jirovecci, 1 mx?

Answer 4

trimethoprim + sulfamethoxazole

Question 5

70M lives alone, haemoptysis 20mL bright red this AM, productive cough few weeks, fevers, night sweats, COPD, HTN, cholesterol, OA, ex-smoker, Spiriva, salb, simvastatin, perindopril, 5hx

Answer 5

• chest pain?
• shortness of breath?
• unintended weight loss?
• pleuritic chest pain
• bone pain
• contact with TB overseas travel?

Question 6

70M lives alone, haemoptysis 20mL bright red this AM, productive cough few weeks, fevers, night sweats, COPD, HTN, cholesterol, OA, ex-smoker, Spiriva, salb, simvastatin, perindopril, ?left upper lobe carcinoma vs. TB, 2Mx

Answer 6

• urgent referral to respiratory physician/oncologist
• explain concern for lung cancer
• attend ED if any large volume haemoptysis

Question 7

70M lives alone, haemoptysis 20mL bright red this AM, productive cough few weeks, fevers, night sweats, COPD, HTN, cholesterol, OA, ex-smoker, Spiriva, salb, simvastatin, perindopril, ?left upper lobe carcinoma vs. TB, refusing Ix/Rx, competent, 4mx

Answer 7

• accept patient’s decision
• explain consequences
• offer written information
• document in notes about refusal
• refer to community palliative care
• discuss end of life issues, advanced care plan