Study Guide for NU 545 Unit 4 - High-Score Study Material

Study Guide for NU 545 Unit 4 - High-Score Study Material Infectious Mononucleosis p. 966 - answer - A benign, acute, self-limiting lymphoproliferative clinical syndrome characterized by acute viral infection of B lymphocytes (B cells). Associated with several tumors, most commonly specific lymphomas and nasopharyngeal carcinoma. Most common cause- EBV. Major manifestations of EBV induced IM: Pharyngitis, lymphadenopathy, Fever. Other viral causes for IM: CMV, adenovirus, HIV, Hep A, Influenza A&B, Rubella. Transmission of EBV: Saliva (Kissing Disease), secretions of genitalia rectum resp tract & blood. 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 systemicaly. Patho of Infectious Mononucleosis p. 966 - answer - 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. Complications of infection Mononucleosis p. 967 fig 30.1 - answer - Lymphadenitis hepatitis Splenitis Pneumonitis Meningitis Encephalitis Clinical manifestations of infectious mononucleosis p. 967 - answer - Incubation period: 30-50 days (4-8 weeks), then a 3-5 day prodrome of fever, malaise, arthralgias (joint pain). These symptoms vary in severity for the next 7-20 days. At time of dx patient has classic triad of symptoms: fever, pharyngitis, lymphadenopathy of 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 Eval and Tx of infectious mononucleosis p. 967 - answer - Children present w/: fever, sore throat, lymphadenitis, Young adults present w/: malaise, fatigue, lymphadenopathy and fever of unknown origin. Blood contains increased # of atypical lymphocytes. Dx based on Hoagland's criteria: 50% lymphocytes, 10% atypical lymphocytes in the blood with presence of fever, pharyngitis, adenopathy confirmed by a + serologic test. Serological test: heterophile antibodies, Monospot test (limited bc 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. Pharyngitis of Strep origin tx w/ PCN or erythromycin. NO ampicillin (causes rash in patients with IM) Avoid strenuous activities. Steroids only with severe complications. Acyclovir with immunocompromised. Leukemia p. 968 - 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