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NU 545 UNIT 4 | 2025-2026 LATEST UPDATED| REAL EXAM
QUESTIONS AND ANSWERS | 100% RATED CORRECT | 100% VERFIED
| ALREADY GRADED A+
Infectious Mononucleosis (IM) p. 945 - (answer)A benign, acute, self-limiting
lymphoproliferative clinical syndrome characterized by acute viral infection of B lymphocytes
(B cells). Associated with several tumors, such as B cell and T cell, Hodgkin lymphoma (HL)
and nasopharyngeal carcinoma. Linked to post-transplant lymphoproliferative diseases (PTLD)
and gastric carcinoma. Most common cause- EBV (herpes virus). 90% of people have antibodies,
early infections rarely develop into IM. During adolescence or later 35-50% get IM (p945).
Transmission of EBV: Saliva (Kissing Disease), secretions of genital, rectal, resp tract & blood,
cervical and seminal fluid.. No aerosol transmission. Disease begins with widespread infection of
B lymphocytes which have receptors for EBV. Virus initially infects oropharynx, nasopharynx,
and salivary epithelial cells then spreads to lymphoid tissue and B cells. Infection of B cells
allows the virus to enter the bloodstream, then the virus spreads systemically (p946)
Patho of Infectious Mononucleosis p. 946 - (answer)Immunodeficiency, infected B cells may be
uncontrolled and lead to B-cell lymphoma. In the immunocompetent patient, unaffected B cells
produce antibodies (IgG, IgM, IgA) against the virus. There is a massive activation of
proliferation of cytotoxic T cells (CD8) directed against EBV infected cells. Immune response
against EBV is largely responsible for cellular proliferation in the lymphoid tissue (lymph nodes,
spleen, tonsils, liver). Sore throat and fever are the earliest manifestations d/t inflammation at the
site of viral entry and initial infection, usually the mouth and throat.
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Clinical manifestations of infectious mononucleosis p. 946 - (answer)Pharyngitis (sore throat),
lymphadenopathy, and fever (p945). Incubation period: 30-50 days (4-8 weeks), then a 3-5 day
prodrome of HA, fever, malaise, arthralgias (joint pain). cervical lymph nodes. Pharyngitis:
whitish, greyish green thick exudate. Severe complications: meningitis, encephalitis, guillain
barre syndrome, bells palsy, optic neuritis, mental impairment, transverse myelitis, cerebellar
ataxia, demyelinating disease.
Ocular manifestations: eyelid/periorbital edema, dry eyes, keratitis, uveitis, conjunctivitis,
retinitis, oculoglandular syndrome, choroiditis, papillitis, ophthalmoplegia.
In child: Reye syndrome.
Pulmonary involvement: RARE- hilar and mediastinal lymphadenopathy, interstitial
pneumonitis, pleural effusions, pneumonia and resp fail in immunocompromised patient. Older
patient with 2 weeks of temp that can't be explained EBV should be suspected, Most common
cause of death is splenic rupture (rare, 0.1-0.5%) r/t mild trauma in men <25 between 4 and 21
days after symptoms. Other deaths: hepatic failure, bacterial infection, viral myocarditis.
Eval and Tx of infectious mononucleosis p. 947 - (answer)Children present w/: fever, pharyngitis
(sore throat), lymphadenitis.
Young adults present w/: malaise, fatigue, lymphadenopathy and fever of unknown origin.
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Palatal petechiae (redish-brown spots on roof of mouth), splenomegaly, and posterior cervical
adenopathy (lymphnodes).
Blood contains increased WBC (lymphocytes).
Dx based on Hoagland's criteria: 50% lymphocytes, 10% atypical lymphocytes in the blood with
positive heterophile antibody (IgM) with Monospot test. presence of fever, pharyngitis,
adenopathy confirmed by a + serologic test. Serological test: heterophile antibodies,
Monospot test (limited b/c CMV, adenovirus, toxoplasmosis also produce heterophilic antibodies
causing false +).
Tx: IM is usually self limiting and intervention is rarely required. Rest & alleviation of
symptoms. No ASA used with child or adolescent d/t reye syndrome. Streptococcal pharyngitis
(20-30% cases) tx w/ PCN or erythromycin. NO ampicillin (causes rash in patients with IM).
Avoid strenuous activities. Steroids only with severe complications (airway obstruction).
Acyclovir with immunocompromised pts.
Complications of Infectious Mononucleosis - (answer)B-cell and T-cell lymphomas, Hodgkin
Lymphoma (HL), and nasopharyngeal carcinoma.
Post transplant lymphoproliferative diseases (PTLDs), gastric carcinoma
Pharyngitis (sore throat)
, 4|Page
Lymphadenopathy
Fever
Burkitt lymphoma (BL)
HA
Malaise
Joint pain
Fatigue
Cervical Lymph node enlargement
Progression:
Lymphadenopathy
hepatitis/hepatic failure w/ jaundice and anemia
Splenitis/splenomegaly/splenic rupture
Myocarditis
Bacterial infection
Activated T lymphocytes (mononucleosis cells) in blood
Pneumonitis
Meningitis
Encephalitis
NU 545 UNIT 4 | 2025-2026 LATEST UPDATED| REAL EXAM
QUESTIONS AND ANSWERS | 100% RATED CORRECT | 100% VERFIED
| ALREADY GRADED A+
Infectious Mononucleosis (IM) p. 945 - (answer)A benign, acute, self-limiting
lymphoproliferative clinical syndrome characterized by acute viral infection of B lymphocytes
(B cells). Associated with several tumors, such as B cell and T cell, Hodgkin lymphoma (HL)
and nasopharyngeal carcinoma. Linked to post-transplant lymphoproliferative diseases (PTLD)
and gastric carcinoma. Most common cause- EBV (herpes virus). 90% of people have antibodies,
early infections rarely develop into IM. During adolescence or later 35-50% get IM (p945).
Transmission of EBV: Saliva (Kissing Disease), secretions of genital, rectal, resp tract & blood,
cervical and seminal fluid.. No aerosol transmission. Disease begins with widespread infection of
B lymphocytes which have receptors for EBV. Virus initially infects oropharynx, nasopharynx,
and salivary epithelial cells then spreads to lymphoid tissue and B cells. Infection of B cells
allows the virus to enter the bloodstream, then the virus spreads systemically (p946)
Patho of Infectious Mononucleosis p. 946 - (answer)Immunodeficiency, infected B cells may be
uncontrolled and lead to B-cell lymphoma. In the immunocompetent patient, unaffected B cells
produce antibodies (IgG, IgM, IgA) against the virus. There is a massive activation of
proliferation of cytotoxic T cells (CD8) directed against EBV infected cells. Immune response
against EBV is largely responsible for cellular proliferation in the lymphoid tissue (lymph nodes,
spleen, tonsils, liver). Sore throat and fever are the earliest manifestations d/t inflammation at the
site of viral entry and initial infection, usually the mouth and throat.
,2|Page
Clinical manifestations of infectious mononucleosis p. 946 - (answer)Pharyngitis (sore throat),
lymphadenopathy, and fever (p945). Incubation period: 30-50 days (4-8 weeks), then a 3-5 day
prodrome of HA, fever, malaise, arthralgias (joint pain). cervical lymph nodes. Pharyngitis:
whitish, greyish green thick exudate. Severe complications: meningitis, encephalitis, guillain
barre syndrome, bells palsy, optic neuritis, mental impairment, transverse myelitis, cerebellar
ataxia, demyelinating disease.
Ocular manifestations: eyelid/periorbital edema, dry eyes, keratitis, uveitis, conjunctivitis,
retinitis, oculoglandular syndrome, choroiditis, papillitis, ophthalmoplegia.
In child: Reye syndrome.
Pulmonary involvement: RARE- hilar and mediastinal lymphadenopathy, interstitial
pneumonitis, pleural effusions, pneumonia and resp fail in immunocompromised patient. Older
patient with 2 weeks of temp that can't be explained EBV should be suspected, Most common
cause of death is splenic rupture (rare, 0.1-0.5%) r/t mild trauma in men <25 between 4 and 21
days after symptoms. Other deaths: hepatic failure, bacterial infection, viral myocarditis.
Eval and Tx of infectious mononucleosis p. 947 - (answer)Children present w/: fever, pharyngitis
(sore throat), lymphadenitis.
Young adults present w/: malaise, fatigue, lymphadenopathy and fever of unknown origin.
,3|Page
Palatal petechiae (redish-brown spots on roof of mouth), splenomegaly, and posterior cervical
adenopathy (lymphnodes).
Blood contains increased WBC (lymphocytes).
Dx based on Hoagland's criteria: 50% lymphocytes, 10% atypical lymphocytes in the blood with
positive heterophile antibody (IgM) with Monospot test. presence of fever, pharyngitis,
adenopathy confirmed by a + serologic test. Serological test: heterophile antibodies,
Monospot test (limited b/c CMV, adenovirus, toxoplasmosis also produce heterophilic antibodies
causing false +).
Tx: IM is usually self limiting and intervention is rarely required. Rest & alleviation of
symptoms. No ASA used with child or adolescent d/t reye syndrome. Streptococcal pharyngitis
(20-30% cases) tx w/ PCN or erythromycin. NO ampicillin (causes rash in patients with IM).
Avoid strenuous activities. Steroids only with severe complications (airway obstruction).
Acyclovir with immunocompromised pts.
Complications of Infectious Mononucleosis - (answer)B-cell and T-cell lymphomas, Hodgkin
Lymphoma (HL), and nasopharyngeal carcinoma.
Post transplant lymphoproliferative diseases (PTLDs), gastric carcinoma
Pharyngitis (sore throat)
, 4|Page
Lymphadenopathy
Fever
Burkitt lymphoma (BL)
HA
Malaise
Joint pain
Fatigue
Cervical Lymph node enlargement
Progression:
Lymphadenopathy
hepatitis/hepatic failure w/ jaundice and anemia
Splenitis/splenomegaly/splenic rupture
Myocarditis
Bacterial infection
Activated T lymphocytes (mononucleosis cells) in blood
Pneumonitis
Meningitis
Encephalitis
