PBL Sessions: AIDS


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Page 6

History of Present Illness (Celeste):

Celeste is in her 36th week. A repeat HIV test is positive, confirmed by Western blot. She has developed nausea with vomiting for the past 2 days. She does not have headaches. On examination vital signs include T 37 C, P 80/min, RR 16/min, and BP 140/90 mm Hg. She has 1+ pitting edema of her lower legs bilaterally.

Laboratory studies show a CBC with Hgb 10.6 g/dL, Hct 31%, MCV 84 fL, platelet count 166,300/microliter, and WBC count 4420/microliter with differential count 69 segs, 2 bands, 16 lymphs, and 13 monos. Her HIV1-RNA level is 100 copies/mL. Her CD4 count is 350/microliter. Serum chemistries show sodium 144 mmol/L, potassium 4.2 mmol/L, chloride 105 mmol/L, CO2 26 mmol/L, creatinine 1.1 mg/dL, glucose 80 mg/dL, amylase 40 U/L, AST 39 U/L, ALT 28 U/L, total protein 6.6 g/dL, albumin 4.4 g/dL, and total bilirubin 0.9 mg/dL.

Issues regarding risk factors for HIV infection are raised by the family.

Tasks

  • What do these findings indicate?

  • What do you tell the family regarding HIV risks?

  • What hypotheses explain these findings?

  • Explain the pathophysiologic mechanisms.

Stop !! Complete discussions and tasks before moving to the next page.