MKSAP: 33-year-old woman with whitish spots in the mouth and throat

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 33-year-old woman is evaluated for a 5-week history of whitish spots in the mouth and the back of the throat and discomfort with swallowing solid foods. This is her first episode of these symptoms. She has had no mouth pain, trouble ingesting liquids or pills, nausea, vomiting, diarrhea, fever, chills, sweats, or skin problems. She has a 3-year history of HIV infection and also has moderately severe asthma, which is now well controlled with inhaled medications that were recently prescribed. Her medications are tenofovir, emtricitabine, raltegravir, and inhaled fluticasone and salmeterol. On physical examination, her vital signs are normal. Whitish plaques are seen on the palate and posterior pharynx. The remainder of the physical examination is normal. Her last CD4 cell count was 458/µL. The HIV RNA viral load is undetectable. Which of the following is the most appropriate management of this patient? A: Clotrimazole troches B: Fluticasone cessation C: Intravenous amphotericin B D: Nystatin swish-and-swallow E: Oral fluconazole Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Infectious disease Source Type: blogs