Page 1 of 2: HIV

goldenhand · Credits: 19466 My Scrapbook

A 27-year-old HIV-positive man comes to the outpatient clinic with bilateral cheek swelling. He is asymptomatic and otherwise healthy. CD4 count is 380 cells/mm3. On examination, he has bilateral, diffuse, nontender enlargement of the parotid glands. Magnetic resonance imaging shows numerous cysts scattered throughout the substance of both parotid glands without any discrete masses identified. Which of the following is the most appropriate next step in management?

A.Observe him and recommend symptomatic therapy

B.Order sialography to image the parotid ducts

C.Refer him for a biopsy of the parotid gland

D.Refer him for a fine-needle aspiration of the parotid gland

E.Send him for radiation therapy to decrease the development of parotid cysts

brokenheart · Credits: 8297 My Scrapbook

Observe him and recommend symptomatic therapy

would resolve with cmbination retroviral therapy if not then refer for surgery

brokenheart · Credits: 8297 My Scrapbook

but b4 that do FNAC

Objective: Bilateral and multiple lymphoepithelial cysts (LECs) of major salivary glands, in particular of parotid glands, are quite rare and have been reported in human immunodeficiency virus (HIV) infected patients with an incidence of about 3–6%. These lesions represent an early manifestation of HIV infection and are rarely found in patients with advanced acquired immunodeficiency syndrome.

Materials: Two cases of parotid LECs, the first occurring in a middle-age white woman and the second in a young white boy, both in advanced phases of HIV infection, are reported.

Results: Clinical, cytological, histological and immunohistochemical (cytokeratin AE1/AE3, CD20, CD45RA, CD8, κ and λ immunoglobulin light chains, S-100, MLA and Ki67) features are described.

Conclusions: Fine needle aspiration (FNA), a relatively non-traumatic procedure, could represent both a diagnostic and a therapeutic tool in parotid LECs. No surgical therapy is usually required for these lesions and aspiration of cystic fluid with FNA is quite resolutive, although evidence of further relapses does exist. Surgical excision may become necessary when pain, because of persistent and progressive swelling of the parotid gland, occurs

goldenhand · Credits: 19466 My Scrapbook

Dr.Brokenheart why did u change ur answer?
The correct answer is A. HIV-associated salivary gland enlargement is an idiopathic but relatively common finding in HIV-positive patients and some HIV-negative high-risk patients. It is characterized by diffuse development of cysts throughout one or both parotid glands, and it is a benign process. Although some investigators have reported the possibility of lymphoma in these patients, this is unlikely when there is no discrete mass identified on imaging studies. There is the potential for xerostomia (dry mouth), as the inflammatory process that is associated with cyst development eventually compromises gland function. In these cases, symptomatic management is appropriate.
Sialography (choice B) would provide little useful information in this patient, as duct obstruction plays no role in its pathogenesis.
Biopsy (choice C) and fine-needle aspiration (choice D) are measures that can provide a tissue diagnosis. Not only are they unnecessary in this patient, but also without a discrete mass it would be difficult to imagine a specific suspicious area of the gland to target with these invasive procedures.
Radiation therapy (choice E) is not used to treat non-neoplastic parotid lesions of this nature.

brokenheart · Credits: 8297 My Scrapbook

thanx dr. goldenhand

my answer is still the same as A

as i mentioned in second post only go for FNAC if painful and palpable mass ...while asnwering for the second time i did not reconsider the mass and it's features ...very poor insight i must say

caillou · Credits: 2617 My Scrapbook

A.Observe him and recommend symptomatic therapy

le bon travail !!

doctormoony · Credits: 6682 My Scrapbook

observe and symptomatic ttt

goldenhand · Credits: 19466 My Scrapbook

Both of u are right.Infact this question as well as the answer & the explanation are from a highly reliable source.

Dr_ER · Credits: 3287 My Scrapbook

Hi Goldenhand I have read alot about you, you look very organised ,will you be able to suggest some of your expert tips on part 1 exam.

Thank you in advance.

goldenhand · Credits: 19466 My Scrapbook

I'm no expert,anyhow my personal reecommendations:
TN very very thoroughly,atleast 2-3 times
Old questions not that these will get repeated but to practise
Study group will help a lot provided all the group members are approx at the same level
Other sources like Kaplan lecture notes,UW,Current medicine-But these are optional if u have time.
Hope it helps.

		Sign In New User? Sign Up Sign in to access your control panel and messenger!
				TechZone \| SpiderNevi \| HowTo? \| Scrapbook!