A 35-year-old female has progressive numbness of the right arm and difficulty seeing objects in the left visual field. She is known to be HIV-positive, but has not consistently taken medications in the past. On examination, she appears healthy, but has a right homonymous hemianopsia and decreased sensory perception in her left upper extremity and face. Her CD4 count is 75 cells per µL, and her MRI is consistent with a demylinating lesion of the left parietooccipital area. CSF PCR for JC virus is positive.
a. Amphotericin B
b. Cranial radiation
c. Highly active antiretroviral therapy (HAART)
d. Intravenous acyclovir
e. Intravenous ceftriaxone
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Highly active antiretroviral therapy (HAART).
The patient has progressive multifocal leukoencephalopathy. It is caused by the JC virus, which is a double-stranded DNA virus. The prognosis is poor, but HAART has been known to be effective in improving survival. JC virus is ubiquitous and may be transmitted through respiratory secretions. Cranial radiation is used to treat malignancies. Amphotericin B is used to treat fungal infections. Intravenous acyclovir is not effective against JC virus, but is used to treat herpes simplex virus encephalitis. Intravenous ceftriaxone is used to treat bacterial meningitis.