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MMLU / A 31-year-old man with a 5-year history of HIV infection comes to the office…

Problem

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question

A 31-year-old man with a 5-year history of HIV infection comes to the office because of anal pain, particularly on defecation, for the past 4 months. He says he has seen spots of blood on the toilet tissue but has not had any other noticeable bleeding. He reports no change in bowel habits and has not had recent fever, chills, or rectal drainage. He says he and his partner engage in anal-receptive intercourse. His most recent CD4+ T-lymphocyte count 2 months ago was 350/mm3 ; HIV viral load at that time was undetectable. He currently is being treated with antiretroviral therapy. He has had no opportunistic infections. Medical history is also significant for syphilis and genital herpes treated with penicillin and acyclovir, respectively. He does not smoke cigarettes or drink alcoholic beverages. Vital signs are normal. Physical examination shows small bilateral inguinal lymph nodes, but respiratory, cardiac, and abdominal examinations disclose no abnormalities. There are several tender fleshy lesions around the perianal area. Rectal examination produces tenderness, but there is no rectal discharge. Test of the stool for occult blood is trace positive. Which of the following is the most appropriate pharmacotherapy at this time?

choices

  1. Acyclovir
  2. Imiquimod
  3. Levofloxacin
  4. Metronidazole

subject

professional_medicine

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Source and history

task_id
30139ea6-8925-5ee1-aacd-32628ed83db7
task_key
all--test--30139ea6-8925-5ee1-aacd-32628ed83db7
task_revision_id
1
config / split
all / test

Official source

initial import