#april2020mccqe1
A 32-year-old man with AIDS develops right-sided weakness over the course of 1 week. He is on a combined drug regimen of zidovudine (AZT) and a protease inhibitor, and his CD4 cell count is 190 cells/mL. MRI of the brain reveals a single 2-cm mass in the left cerebral white matter that appears as an area of low signal surrounded by a rim of contrast enhancement (“ring-enhancing lesion”). A trial of sulfadiazine and pyrimethamine is started. Three weeks after beginning this treatment, the patient’s neurologic status is unchanged, and imaging studies show that the lesion has not regressed. Which of the following is the most likely diagnosis?
(A) Cryptococcal meningoencephalitis
(B) Glioblastoma multiforme (GBM)
(C) Metastatic tumor
(D) Primary brain lymphoma
(E) Toxoplasma abscess
A 32-year-old man with AIDS develops right-sided weakness over the course of 1 week. He is on a combined drug regimen of zidovudine (AZT) and a protease inhibitor, and his CD4 cell count is 190 cells/mL. MRI of the brain reveals a single 2-cm mass in the left cerebral white matter that appears as an area of low signal surrounded by a rim of contrast enhancement (“ring-enhancing lesion”). A trial of sulfadiazine and pyrimethamine is started. Three weeks after beginning this treatment, the patient’s neurologic status is unchanged, and imaging studies show that the lesion has not regressed. Which of the following is the most likely diagnosis?
(A) Cryptococcal meningoencephalitis
(B) Glioblastoma multiforme (GBM)
(C) Metastatic tumor
(D) Primary brain lymphoma
(E) Toxoplasma abscess
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