Test TOM - Ordre Des Médecins Practice Questions - Test Préalable à L'Inscription Au Tableau De L'Ordre Des Médecins (Test TOM, DR Congo) Exam

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A 42-year-old male with newly diagnosed advanced HIV infection (CD4 count 45 cells/uL) presents with subacute headache, fever, neck stiffness, and photophobia. Lumbar puncture reveals clear cerebrospinal fluid (CSF) with elevated opening pressure (280 mm H2O), lymphocytic pleocytosis, low glucose, and India ink preparation showing encapsulated budding yeasts. Cryptococcal antigen (CrAg) lateral flow assay is positive. What is the optimal induction management and timing of Antiretroviral Therapy (ART) initiation?

Immediate initiation of TDF + 3TC + DTG on day 1 alongside oral fluconazole 200 mg daily Induction with IV Amphotericin B deoxycholate plus oral Flucytosine (or high-dose Fluconazole 1200 mg/day), therapeutic lumbar punctures for intracranial hypertension, and deferring ART by 4 to 6 weeks from the start of antifungal treatment Immediate high-dose intravenous Dexamethasone for 4 weeks combined with immediate ART initiation to prevent neurological deficit Single-dose intrathecal Methotrexate followed by maintenance Co-trimoxazole prophylaxis

Correct Answer:

Induction with IV Amphotericin B deoxycholate plus oral Flucytosine (or high-dose Fluconazole 1200 mg/day), therapeutic lumbar punctures for intracranial hypertension, and deferring ART by 4 to 6 weeks from the start of antifungal treatment

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