NU 545 UNIT 4 EXAM COMPLETE
QUESTIONS AND VERIFIED SOLUTIONS
LATEST UPDATE
Infectious Mononucleosis (IM) p. 945 - CORRECT 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 - CORRECT 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.
Clinical manifestations of infectious mononucleosis p. 946 - CORRECT
ANSWER ✔✔- Pharyngitis (sore throat), lymphadenopathy, and fever (p945).
1
,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 - CORRECT ANSWER ✔✔-
Children present w/: fever, pharyngitis (sore throat), lymphadenitis.
Young adults present w/: malaise, fatigue, lymphadenopathy and fever of unknown
origin.
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,
2
,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 - CORRECT ANSWER ✔✔- B-cell
and T-cell lymphomas, Hodgkin Lymphoma (HL), and nasopharyngeal carcinoma.
Post transplant lymphoproliferative diseases (PTLDs), gastric carcinoma
Pharyngitis (sore throat)
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
3
, Pneumonitis
Meningitis
Encephalitis
Guillain-Barre
Bell Palsy
Eyelid and periorbital edema, dry eyes, keratitis, uveitis, conjunctivitis. Reye
syndrome in children.
Pulmonary and respiratory failure.
Maculopapular, urticarial or petechial rash.
Leukemia p. 947 - CORRECT ANSWER ✔✔- A clonal malignant disorder of
leukocytes in the bone marrow and usually but not always of the blood. Common
feature is an uncontrolled proliferation of malignant leukocytes causing an
overcrowding of bone marrow and decreased production of functional normal
hematopoietic cells. Thus it has been termed as an accumulation disorder as well as
proliferation disorder.
4 types of leukemia p. 947 - CORRECT ANSWER ✔✔- Acute Lymphocytic
(ALL) - an aggressive fast growing leukemia with too many lymphoblasts
(immature WBC) found in the blood and bone marrow.
Acute Myelogenous (AML) - Aggressive fast growing leukemia with an excessive
number of myeloblasts (immature WBC that are not lymphoblasts) found in bone
marrow and blood.
Chronic Lymphocytic (CLL)
Chronic Myelogenous (CML)
Acute Leukemia
Patho, Clinical manifestations, diagnostics, treatment and complications p. 947 -
CORRECT ANSWER ✔✔- Characterized by undifferentiated or immature cells,
4
QUESTIONS AND VERIFIED SOLUTIONS
LATEST UPDATE
Infectious Mononucleosis (IM) p. 945 - CORRECT 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 - CORRECT 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.
Clinical manifestations of infectious mononucleosis p. 946 - CORRECT
ANSWER ✔✔- Pharyngitis (sore throat), lymphadenopathy, and fever (p945).
1
,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 - CORRECT ANSWER ✔✔-
Children present w/: fever, pharyngitis (sore throat), lymphadenitis.
Young adults present w/: malaise, fatigue, lymphadenopathy and fever of unknown
origin.
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,
2
,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 - CORRECT ANSWER ✔✔- B-cell
and T-cell lymphomas, Hodgkin Lymphoma (HL), and nasopharyngeal carcinoma.
Post transplant lymphoproliferative diseases (PTLDs), gastric carcinoma
Pharyngitis (sore throat)
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
3
, Pneumonitis
Meningitis
Encephalitis
Guillain-Barre
Bell Palsy
Eyelid and periorbital edema, dry eyes, keratitis, uveitis, conjunctivitis. Reye
syndrome in children.
Pulmonary and respiratory failure.
Maculopapular, urticarial or petechial rash.
Leukemia p. 947 - CORRECT ANSWER ✔✔- A clonal malignant disorder of
leukocytes in the bone marrow and usually but not always of the blood. Common
feature is an uncontrolled proliferation of malignant leukocytes causing an
overcrowding of bone marrow and decreased production of functional normal
hematopoietic cells. Thus it has been termed as an accumulation disorder as well as
proliferation disorder.
4 types of leukemia p. 947 - CORRECT ANSWER ✔✔- Acute Lymphocytic
(ALL) - an aggressive fast growing leukemia with too many lymphoblasts
(immature WBC) found in the blood and bone marrow.
Acute Myelogenous (AML) - Aggressive fast growing leukemia with an excessive
number of myeloblasts (immature WBC that are not lymphoblasts) found in bone
marrow and blood.
Chronic Lymphocytic (CLL)
Chronic Myelogenous (CML)
Acute Leukemia
Patho, Clinical manifestations, diagnostics, treatment and complications p. 947 -
CORRECT ANSWER ✔✔- Characterized by undifferentiated or immature cells,
4
