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Thyroid nodule with suspicious ultrasound features — RCPSC IM MCQ

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HardEndocrinologyThyroid nodule with suspicious ultrasound featuresRCPSC IM

A patient with HIV has CD4 count 42 cells/µL, positive serum cryptococcal antigen and no headache, confusion or neck stiffness. What should occur before starting antiretroviral therapy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Perform lumbar puncture before antiretroviral therapy

Positive cryptococcal antigen at a low CD4 count requires evaluation for CNS disease, including lumbar puncture when safe, because treatment and ART timing differ in meningitis. Immediate ART without evaluation risks unmasking or worsening disease.

Reference: Public Health Ontario, Infectious Diseases Resources: https://www.publichealthontario.ca/