please answer NOT NBME q - confusedclinician

[ArchivalUser]

i will go for DD
A= it is invasive procedure so think lastly
B and C pt already on PCP prophylaxis,it is also for toxo. so less likely
E= if you start anti TB with very low CD4 count pt's get IRS(immune reconsitution syndrome)

[ArchivalUser]

D.

PML on CT scan has mutiple lesions w/ no mass effect. also he is on TMP/SMZ so that rules out toxoplasmosis.

[ArchivalUser]

ans is D i believe because

A --wont do until tx fails,
C--dont waste time according to MTB3 when the head ct shows ring enhancing lesion start empiric tx with pyrimethamine+ sulfadiazine for 2 wks then repeat the ct scan to see if it shrinks.....basically when you have these patients its like trial and error,...until you get it
by the way,......PML is totally wayyyy out because there are no ring enhancing lesions

[ArchivalUser]

omg i apologise i wrote the wrong ans choice, to the above post , my answer is B

[ArchivalUser]

cns lymphoma
answer D

[ArchivalUser]

b i guess