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Case ID: 1
Created: 5 Dec 2010

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Station 4 ( Counselling Station):

Subject Mrs Goh- 24 years old lady

You are required to see Mrs Goh whom her husband was recently admitted to ward due to pneumonia and was later found to have pneumocystic carinii penumonia. Mr Lee's HIV testing later was confirmed to be positive. Mr Lee has agreed that his wife to be informed of his HIV status. Your task is to explain to Mrs Goh about her husband HIV status and advise her to get her HIV test done.

You are also informed by your clinic sister that Mrs Goh recently just found out that she is pregnant!



It is certainly a popular topic in MRCP PACES counselling station. List down your tasks in this station- Informing Mrs Goh that her husband is HIV positive, ask her permission to get her HIV test done and of course you are likely to be asked about HIV related issues in pregnancy. There are various guidelines out there for you about getting consent from patient for HIV testing.

However, I find candidates always have difficulty starting the topic when dealing with this situation. Generally, one principle to follow, always ask the patient/surrogate how much information they have gathered so far, such as in this case, after the initial greeting and introduction, I will start off by saying....

" Mrs Goh, I know that your husband was admitted to our hospital 3 days ago, did anyone inform you about his condition and how much do you know about his condition?"

Depending on situation, how to switch from topic of pneumonia to HIV can be quite easy if Mrs Goh knows a bit about PCP. However, she might be totally unaware of this condition. If this happens, I would like to use the following technique to inform her indirectly that her hsuband might have HIV.

" Mrs Goh, your husband has PCP, a type of very rare penumonia only happens to certain groups of patients who have long weak immune system- such as those who have organ transplantation, post cancer treatments and sometime those who are affected with HIV. Do you have any ideas what is HIV infection?"

So, do you get my meaning? After you have opened teh topic, everything that follows will be easy, you just need to know about the fact,

arrow1) Principles of HIV testing- Please go to this site to learn more about the principles.

arrow2) Pregnancy related issues in HIV- Please go to this site to learn about the common FAQs about HIV in pregnancy. Go to PassPACES download page to download the a review article about HIV in Pregnancy.

Popular questions examiners might ask you during your MRCP PACES,

1) What would you do if Mrs Goh asks your permission for abortion?

2) How do you manage her baby after delivery?

Extra points:

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Created: 5 Dec 2010

Breaking trial in Clinical Medicine/Nephrology



Background History:

    Although statin is well known to be cardioprotective for general population, 2 previous trials looking at statin in End stage renal failure patients ( 4D and AURORA) failed to show benefits of atorvastatin and rosulvastatin) in dialysis patients. SHARP ( Study of Heart and Renal Protection) trial which looks at the benefit of Simvastatin/Ezetimibe on chronic kidney disease and dialysis patients showes positive results.The results of this trial were recently presented during American Society of Nephrology ( ASN) meeting.

Click HERE to look at the report.

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