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Laboratory results include the following: uric acid generic plavix 75 mg online, 8 effective 75mg plavix. Key Concept/Objective: To appreciate comorbid conditions when selecting treatment for acute gout This patient’s acutely painful great toe is suggestive of gout. His uric acid level is high, which is consistent with this diagnosis. Appropriate treatment would be either oral pred- nisone or steroids injected into the joint. He should not receive NSAIDs because he has renal insufficiency. Rofecoxib, a COX-2 inhibitor, can also be detrimental to renal function and should not be used in this setting. Allopurinol is not indicated for the acute treatment of gout. He had his first attack 6 months ago; gout was con- firmed by joint aspiration that revealed uric acid crystals. Three months later, he had a second attack, which involved his knee and left great toe. The medical history includes hypertension, reflux esophagi- tis, and psoriasis. The patient reports drinking one glass of wine once a week. Medications include omeprazole, lisinopril, hydrochlorothiazide, and triamcinolone ointment. What would you recommend for this patient to prevent future episodes of gout?
PCR detection of HSV-1 DNA in the CSF is both sensitive and specific and has become the gold standard in suspected cases of HSV encephalitis buy 75mg plavix with mastercard. Nonetheless generic plavix 75mg overnight delivery, clinicians should be aware that PCR may be negative for HSV in the first few days of illness with HSV encephalitis. A 34-year-old man was found to be HIV seropositive 4 years ago. He began having headaches and low-grade fevers 1 month ago. Previously, his friends noted no change in his functioning, personality, or thinking, but now, he is becoming progressively more confused and has difficulty caring for himself. On examination, the patient’s temperature is 100° F (37. A mental status examination shows diminished cognitive ability. A magnetic resonance imaging study shows global cortical atrophy, no ventricular enlargement, and no focal lesions. Progressive multifocal leukoencephalopathy (PML) C. Cryptococcal meningitis Key Concept/Objective: To understand that because multiple CNS diseases can occur with HIV infection, HIV dementia remains a diagnosis of exclusion Toxoplasmosis presents with fever, headache, focal exam findings, and multiple ring- enhancing brain lesions on imaging studies. PML presents with focal deficits on exam 46 BOARD REVIEW without alteration in consciousness and with multiple white matter lesions on T2-weight- ed MRI images. CNS lymphoma presents with focal neurologic deficits, headache, and one to a few focal brain lesions on radiographic studies. HIV dementia is associated with a slower progression of personality changes, dementia, and unsteady gait. Cortical atrophy and ventricular enlargement are commonly seen on MRI, but the findings are not diag- nostic.
