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The disease is caused by reactivation of latent human papillomavirus JC in the CNS and is thus an opportunistic infection purchase zithromax 250mg on-line. The disease is typically a late manifestation of HIV disease cheap zithromax 250mg free shipping; it occurs in 1% to 5% of HIV-infected persons. The diagnosis should be considered in any person with immun- odeficiency who presents with a subacute, progressive illness involving motor function and cognition. Other considerations in the differential diagnosis for this patient include toxoplasmosis infection, CNS lymphoma, and other CNS infections, such as tuberculosis and neurocysticercosis. MRI findings of multiple, nonenhancing white matter lesions that tend to coalesce are typical. These lesions have a predilection for the occipital and parietal lobes. The definitive diagnosis has previously been established only by brain biopsy, but PCR techniques for the detection of JC virus DNA material in the CSF have been used with increasing success (the reported sensitivity and specificity of these techniques are greater than 90%). Improved outcomes in AIDS patients with PML have been reported with the use of HAART. A woman comes to your clinic with concerns about mad cow disease (bovine spongiform encephalopa- thy [BSE]). She has heard media reports of infected cattle in other countries and of the possible risk of a similar disease spreading to people. She wants to know if it is safe for her and her children to consume beef and dairy products in the United States. Which of the following statements about new-variant Creutzfeldt-Jakob disease (nvCJD) is false? Compared to CJD, nvCJD typically develops in younger adults B. The agent of disease is thought to be a protein, or prion, which is spread by the consumption of animal protein products C. There have been documented cases in the United States D. There is currently minimal risk of acquiring the disease from con- sumption of milk or beef in the United States Key Concept/Objective: To understand the epidemiology of BSE and its association with nvCJD BSE is a spongiform encephalopathy that has occurred primarily in the United Kingdom and is associated with the consumption (by cows) of protein supplements derived from ruminant tissue.
Assessment and Clinical Decision-Making: An Overview 9 Box 1-2 Common Diagnostic Errors Jumping to conclusion safe 500 mg zithromax, being biased by an early finding (e 500 mg zithromax with amex. Accepting previous diagnosis/explanation without exploring other possible explanations (e. Using a shotgun approach to assessment, without adequate focus. Focusing solely on the most obvious or likely explanation. Failure of memory, so only recognize what is memorized or recalled. Using the wrong rule, decision tree, or other resource to guide analysis or using the correct device incorrectly. Allowing other health care professionals to lead you down the wrong diagnosis path. Accepting the “horses” without even contemplating the “zebras”; contemplating “zebras” without adequately pursuing the possibility of a more common condition. Accommodating patient wishes against clinician judgment. Failing to consider medical conditions as the source of “psychiatric” symptoms and psychi- atric conditions as the source of “medical” symptoms. Although not always to the patient’s advantage, patient expectations often play a part in clinical decision-making. Some patients are less willing to wait; others are less willing to be treated. This can be the cause for errors, and clinicians should be aware that they should try to accommodate patients’ wishes without putting them at risk.
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