Pathology EMQ template.

Name: Edward Amiry

Theme: Anti-virals

 

OPTION LIST

 

A	acyclovir	I	zanamivir
B	interferon alpha and ribavirin	J	ganciclovir
C	ribavirin	K	palivizumab
D	zidovucine nevirapine, zanamivir	L	AZT, didanosine, ribavirin
E	co-trimoxazole	M
F	AZT (zidovudine), didanosine, indinavir	N
G	interferon-beta	O
H	ritonavir	P

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A particularly hirsuit man complains of  pain in his side stopping him sleeping. After making a nurse shave his torso, you notice he has a vesicular rash in a strip around his abdomen.

 

2. A very friendly 43 year old HIV-positive male presents to your clinic with decreased visual acuity. Despite this he is quite upbeat and tells you about a great vegetarian pizza he had recently. You decide not to point out the irony as you notice a “pizza” appearance on fundoscopy.

 

3. A baby girl born prematurely at 29 weeks is said to be at “high risk” of suffering from severe respiratory syncytial virus (RSV), your consultant has performed a full assessment of the child but is now in a rush to get to his golf game. On his way out the door he shouts “Be sure you give her the good stuff!”

 

4. A 36 year old man with chronic hepatitis C infection.

 

5. A 28 year old HIV-positive woman has refused to take her medication as she is distressed about her condition. Fortunately, thanks to your clinical communications training, you convince her that treatment is the right way to go. You prescribe highly active anti-retroviral therapy (HAART).

 

 

ANSWERS

1. A

2. J

3. K

4. B

5. F

 

 

1A – Oral aciclovir is the treatment of choice for singles (herpes zoster infection), which this man has as shown by his rash in a dermatomal distribution.

 

2J – CMV retinitis is diagnosed clinically and exhibits a characteristic “pizza” appearance on fundoscopy caused by haemorrhages and exudates that follow the retinal vessels. CMV retinitis is a medical emergency due to the risk of blindness and IV ganciclovir should be administered.

 

3K – Treatment of RSV is inhaled ribavirin (although there is not yet clear evidence that it provides significant benefit). However for prevention of RSV in high risk infants we can use the monoclonal antibody palivizumab.

 

4B – Interferon-alpha is given by subcutaneous injections. Combination therapy with ribavirin is more effective and should go on for 6 months.

 

5F – AZT and didanosine are nucleoside reverse transcriptase inhibitors, while indinavir is a protease inhibitor. These three make up what is commonly referred to as HAART. You may also choose to add nevirapine – a non-nucleoside analogue reverse transcriptase inhibitor. If you're feeling quirky.