Question

A 32-year-old man who is HIV-positive presents to the emergency room with mild fever to 101° F (38.3° C), headache, stiff neck, photophobia, and lethargy. His CD4 count is 0, and he has a highly elevated viral load. The most useful immediate diagnostic test for his current condition would be:

A. Head CT scan with contrast
B. MRI of the brain with and without gadolinium
C. Lumbar puncture for CSF analysis and India ink staining
D. Chest radiography and blood cultures
E. Serum cold agglutinin assay

Answer 1

The most useful immediate diagnostic test for a patient with advanced AIDS presenting with neurological symptoms is a lumbar puncture for CSF analysis and India ink staining to diagnose potential cryptococcal meningitis.

Step-by-step explanation:

The most useful immediate diagnostic test for a 32-year-old man with HIV presenting with symptoms of mild fever, headache, stiff neck, photophobia, and lethargy, and with a CD4 count of 0 and highly elevated viral load, would be C. Lumbar puncture for CSF analysis and India ink staining. These symptoms and lab findings are suggestive of cryptococcal meningitis, a common opportunistic infection in patients with advanced AIDS. Lumbar puncture with subsequent CSF analysis and India ink staining can help diagnose this condition by identifying the presence of Cryptococcus neoformans, the fungus responsible for the infection.