NU 545 UNIT 4 EXAM 2025/2026
QUESTIONS AND ANSWERS 100% PASS
Infectious Mononucleosis (IM) p. 945 - ANS 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 - ANS 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 - ANS 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.
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,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 - ANS 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,
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 - ANS B-cell and T-cell lymphomas, Hodgkin
Lymphoma (HL), and nasopharyngeal carcinoma.
Post transplant lymphoproliferative diseases (PTLDs), gastric carcinoma
Pharyngitis (sore throat)
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,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
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 - ANS 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.
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, 4 types of leukemia p. 947 - ANS 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 -
ANS Characterized by undifferentiated or immature cells, usually a blast cell, and the onset
of disease is abrupt and rapid with a short survival time.
Acute Leukemia p. 970 - ANS Acute leukemia is a result of B and T cell origin
ALL of B cell origin occurs mainly in children involving the mutation required for B cell
development (ETV6 & RUNX1). ALL of T cell origin- Mutation in NOTCH1ALL- defined by > 30%
of lymphoblasts in bone marrow or blood
Clinical Manifestations: ALL- w/in days to a few weeks stormy onset: S/S generally the same
with all acute leukemias: Table 30.2 Fatigue from bone marrow depression, bleeding from
thombocytopenia, fever from infection. Infection usually gram-negative bacilli: E Coli,
Pseudomonas aeruginosa, Klebsiella pheumoniae. Liver, spleen and lymph node enlargement
more common in ALL CNS S/S: HA, V, papilledema, facial palsy, blurred vision, auditory
disturbances, meningeal irritation. Prophylaxis is key with CNS involvement: radiation/chemo
but not needed with ALM bc only 5% of ALM have CNS involvement
Eval/Tx: dx made by exam of blood cells and bone marrow. Blood smear will show low RBC/PLt
count and presence of leukemic blast cells. Bone marrow will show 60-100% blast cells.
Chemotherapy is Tx of choice. Supportive measures: Blood transfusion, ATB, antifungals,
antivirals. Stem Cell transplant ATRA- made in the body from Vit A and helps cells grow and
differentiate. It is a chemotherapeutic agent used for tx. 5 year survival rate for ALL increased
to 65% in adults and 85% in children since 1970.
Philadelphia chromosome is poor prognostic indicator. Myelosuppresion is a consequence of
leukemia and tx. requires hematologic support with blood products.
Chronic Leukemia p. 968 - ANS The predominant cell is more differentiated but does not
function normally, with a relatively slow progression
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QUESTIONS AND ANSWERS 100% PASS
Infectious Mononucleosis (IM) p. 945 - ANS 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 - ANS 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 - ANS 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.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,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 - ANS 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,
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 - ANS B-cell and T-cell lymphomas, Hodgkin
Lymphoma (HL), and nasopharyngeal carcinoma.
Post transplant lymphoproliferative diseases (PTLDs), gastric carcinoma
Pharyngitis (sore throat)
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
,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
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 - ANS 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.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, 4 types of leukemia p. 947 - ANS 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 -
ANS Characterized by undifferentiated or immature cells, usually a blast cell, and the onset
of disease is abrupt and rapid with a short survival time.
Acute Leukemia p. 970 - ANS Acute leukemia is a result of B and T cell origin
ALL of B cell origin occurs mainly in children involving the mutation required for B cell
development (ETV6 & RUNX1). ALL of T cell origin- Mutation in NOTCH1ALL- defined by > 30%
of lymphoblasts in bone marrow or blood
Clinical Manifestations: ALL- w/in days to a few weeks stormy onset: S/S generally the same
with all acute leukemias: Table 30.2 Fatigue from bone marrow depression, bleeding from
thombocytopenia, fever from infection. Infection usually gram-negative bacilli: E Coli,
Pseudomonas aeruginosa, Klebsiella pheumoniae. Liver, spleen and lymph node enlargement
more common in ALL CNS S/S: HA, V, papilledema, facial palsy, blurred vision, auditory
disturbances, meningeal irritation. Prophylaxis is key with CNS involvement: radiation/chemo
but not needed with ALM bc only 5% of ALM have CNS involvement
Eval/Tx: dx made by exam of blood cells and bone marrow. Blood smear will show low RBC/PLt
count and presence of leukemic blast cells. Bone marrow will show 60-100% blast cells.
Chemotherapy is Tx of choice. Supportive measures: Blood transfusion, ATB, antifungals,
antivirals. Stem Cell transplant ATRA- made in the body from Vit A and helps cells grow and
differentiate. It is a chemotherapeutic agent used for tx. 5 year survival rate for ALL increased
to 65% in adults and 85% in children since 1970.
Philadelphia chromosome is poor prognostic indicator. Myelosuppresion is a consequence of
leukemia and tx. requires hematologic support with blood products.
Chronic Leukemia p. 968 - ANS The predominant cell is more differentiated but does not
function normally, with a relatively slow progression
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