The parents of 7 y/o male receive a complaint about

their son from his teacher stating that he keeps staring

off into space and ignoring her questions sometimes.
He usually claims ignorance to the fact he is ignoring
her. Which of the following aids in the diagnosis of this
patient’s most likely underlying issue?

A. A pattern of angry/irritable mood, argumentative/defiant

behavior, or vindictiveness lasting at least 6 months
B. Symptoms must be observed in multiple settings for six months or
more
C. 3Hz spike-wave complexes with normal background on EEG
D. 4-6Hz polyspikes and slow wave complexes on EEG
The Answer is c

This patient is the classic description of absence seizure. This description (including the teacher
complaint) will definitely show up in your studying for Step I. You actually do have to have to
remember the EEG pattern for this type of seizure

For answers A and B, I gave you guys a preview of some psych definitions. Answer A describes
opposition defiant disorder and B describes attention deficit disorder. Both of these disorders
are usually diagnosed in childhood and they are the classic wrong answers for a child who has
absence seizures. You will hear all about them next week

Answer D describes juvenile epilepsy. Don’t worry about memorizing this pattern. Just
remember absence is a low Hz (only 3) , spike and wave , and normal background
 A 23 y/o male with seizure d/o presents following a
seizure. The patient loss consciousness during the
seizure, but a witness describes seeing the patient
perform repetitive lip smacking and chewing during the
seizure. Where can you localize the seizure focus?

A. Frontal lobe
B. Brainstem
C. Temporal lobe
D. Occipital lobe
The Answer is c

First off, this is what you need to know about how to classify seizures.
The Answer is c

Second, the temporal lobe is the most common seizure focus (where the epileptic activity
originates). It’s usually in the mesial (medial) temporal lobe.
http://www.cse.buffalo.edu/~rapaport/575/F07/medtemplobes.jpg

There people may have aura’s

1) déjà vu,
2) rising epigastric sensation

And the movements from the questions called automatism

B: seizure’s don’t start here

A: Frontal’s seizure are less common and have weird specific manifestations and these are
more likely to come up in the clerkship than Step 1.
supplementary motor area with Fencer’s posturing
complex partial seizures with vigorous rocking, bicycling, or vocalization with minimal
impairment of consciousness
partial simple motor seizures, Jacksonian seizure (march).

D: You’d see visual manifestations

A 32 year old man with known HIV on HAART presents to his doctor for a general
check up. Which of the following is NOT appropriate counseling for this patient?

A. Even though he is on HAART he is at increased risk for cardiovascular disease and

certain cancers.
B. His HIV viral load is a good marker of being adherent to an appropriate HAART
regimen
C. Condom use is the only way to decrease the risk of transmission to his
serodiscordant partner.
D. His CD4 count is the best predictor of his prognosis and his susceptibility to
opportunistic infections.
A 32 year old man with known HIV on HAART presents to his doctor for a general
check up. Which of the following is NOT appropriate counseling for this patient?

A. Even though he is on HAART he is at increased risk for cardiovascular disease and

certain cancers.
B. His HIV viral load is a good marker of being adherent to an appropriate HAART
regimen
C. Condom use is the only way to decrease the risk of transmission to his
serodiscordant partner.
D. His CD4 count is the best predictor of his prognosis and his susceptibility to
opportunistic infections.

Pre-exposure prophylaxis, or PREP, involves antiretroviral therapy taken by the

seronegative partner and is an effective way of reducing transmission of HIV between
serodiscordant couples. Of course, condoms are an excellent way of preventing HIV
transmission and should be used.
 27 year old male with HIV and CD4 count of 20. Make the following associations.
Note: this is a huge simplification of clinical medicine but reflects useful keyword
associations for your tests!

1. Hairy Leukoplakia
A. Bilateral, fluffy infiltrates on CXR
B. Eye pain and vision problems, 1. Early HIV/can happen anytime
threatens visual acuity
C. White film on the mouth, can scrape 2. Oral candidiasis
off
D. White film in the mouth, cannot 3. Cryptococcus meningitis
scrape off
E. Caused by HHV8 4. Cryptosporidium
F. Subacute (over 2-3 weeks)
presentation of altered mental status 5. Toxoplasma
G. Focal neurologic findings and seizure
H. Multiple bouts of bacterial 6. Cryptococcus Meningitis
pneumonia
I. Ohio river valley, pulmonary 7. Kaposi Sarcoma
symptoms and overall very sick
J. Profuse diarrhea 8. CMV retinitis

9. PCP
 27 year old male with HIV and CD4 count of 20. Make the following associations.
Note: this is a huge simplification of clinical medicine but reflects useful keyword
associations for your tests!

1. Hairy Leukoplakia
A. Bilateral, fluffy infiltrates on CXR
B. Eye pain and vision problems, 1. Early HIV/can happen anytime
threatens visual acuity
C. White film on the mouth, can scrape 1. Oral candidiasis
off
D. White film in the mouth, cannot 2. Cryptococcus
scrape off
E. Caused by HHV8 3. Cryptosporidium
F. Subacute (over 2-3 weeks)
presentation of altered mental status 4. Toxoplasma
G. Focal neurologic findings and seizure
H. Multiple bouts of bacterial 5. Histoplasmosis
pneumonia
I. Ohio river valley, pulmonary 6. Kaposi Sarcoma
symptoms and overall very sick
J. Profuse diarrhea 7. CMV retinitis

8. PCP
A 27 year old man with known HIV who is noncompliant with HAART therapy presents
to the emergency room with eye pain and decreased visual acuity. Which of the
following is an important consideration?

A. CMV retinitis is diagnosed clinically on ophthalmologic exam, as serum studies are

not helpful in making the diagnosis.
B. He was at high risk for CMV infection as soon as his CD4 count drops below 200
and should have received prophylaxis.
C. He should be treated immediately since CMV retinitis can cause vision loss.
D. There is concern for CMV retinitis here that must be addressed; luckily in HIV we
don’t see other manifestations of CMV infection.
E. A and C
A 27 year old man with known HIV who is noncompliant with HAART therapy presents
to the emergency room with eye pain and decreased visual acuity. Ophthalmologic
exam is concerning for CMV retinitis. Which of the following is an important
consideration?

A. CMV retinitis is diagnosed clinically on ophthalmologic exam, as serum studies are

not helpful in making the diagnosis.
B. He was at high risk for CMV infection as soon as his CD4 count drops below 200
and should have received prophylaxis.
C. He should be treated immediately since CMV retinitis can cause vision loss.
D. There is concern for CMV retinitis here that must be addressed; luckily in HIV we
don’t see other manifestations of CMV infection.
E. A and C
CMV retinitis is a clinical diagnosis that is made on ophthalmologic exam and
immediate treatment is necessary to prevent vision loss. B is not the best answer
because although you are at increased risk for all opportunistic infections with
decreased CD4 count, CMV retinitis usually occurs with CD4 counts closer to 50. There
is not standard prophylaxis for CMV. D is not correct because CMV can cause damage
to a variety of organs, not just the eyes.