Question: Patient InformationMr. Johnson Is A 20 Year Old Male Who Tested Positive For HIV 2 Years Ago. He Has Regular Follow-ups With The HIV Clinic Every 3 Months. He Has Been Stable On Antiretroviral Therapy For The Past 12 Months. He Is In The Clinic Today With Concerns Of Moderate Dyspnea, A Persistent And Non-productive Cough, And Fatigue.Review Of Systems:No …

Patient Information

Mr.Johnson is a 20 year old male who tested positive for HIV 2 yearsago. He has regular follow-ups with the HIV clinic every 3 months.He has been stable on antiretroviral therapy for the past 12months. He is in the clinic today with concerns of moderatedyspnea, a persistent and non-productive cough, and fatigue.

Review ofSystems:

Nonausea, vomiting, diarrhea, chills, night sweats, headache, urinaryfrequency, nocturia, or pain with urination.

Hehas had loss of appetite and lost 5lbs in the last week.

Hecontinues to have dyspnea, a non-productive cough, and fatigue.

Allergies:Trimethoprim-Sulfamethoxazole (fever/rash)

SocialHistory:

Sexual preference: Male, new stable partner, engages in unprotectedoral and anal intercourse

Smoked 3 ppd for 10 years, quit 2 years ago, no relapsesreported

Priorhistory of IV drug use and alcohol abuse, completed inpatienttreatment for this and has been drug and alcohol free for the past5 years.

PhysicalExam:

VS:BP 130/87, HR 98, RR 30, T 101.9

General: thin, acutely ill-appearing, young male withtachycardia

Skin:soft, intact, warm, dry. No visible lesions, rash, ecchymosis,petechiae, or cyanosis

HEENT(Head, Ears, Eyes, Nose, Throat): PERRLA, ear and nose clear,non nasal passage swelling, sinuses non-tender, oral cavitynegative for erythema, exudates or lesions.

Neck/Lymph Nodes: Neck supple with no masses or bruits. Slightcervical lymphadenopathy, thyroid normal.

Chestand Lungs: Minimal axillary lymphadenopathy, bilateral lower lunglobe crackles with auscultation.

Heart: Normal sinus rhythm, Normal S1 and S2, no rubs, murmurs, orgallops present.

Abdomen: Soft and non-tender, no hepatosplenomegaly, bowel soundsactive in all 4 quadrants, no costovertebral angel tenderness

Neurologic: Alert and oriented x3. Normal deep tendon reflexes. Nofocal neurologic deficits.

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1. Iidentify the two most significant risk factors our patient hadfor developing HIV. Share reasons why you selectedthese two.
2. Did this patient have any other risk factors? If so, what arethey?
3. Explain the pathophysiology of HIV and how it impacts hisability to fight infections.
4. Given the information above what are you most concerned thatMr. Johnson has? Identify the specific clinical signs that led youto this decision and patient education you will provide.