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Pathophysiology NU545 Unit 4 Questions
and Answers (Expert Solutions)
Q: Infectious Mononucleosis, 🗹🗹: An acute, self-limiting viral infection of B cells,
most commonly caused Epstein - Barr Virus ( EBV) but can be caused by CMV,
adenovirus, hepatitis A, influenza A and B, rubella, bacteria toxoplasma gondii,
corynebacterium diptheriae, and coxiella burnetii.
Q: Infectious Mononucleosis triad of symptoms, 🗹🗹: Pharyngitis, lymphadenopathy,
fever
Q: Infectious Mononucleosis, 🗹🗹: Transmission is through saliva ("kissing disease")
and blood
Q: Incubation period Mononucleosis, 🗹🗹: Approx. 30-50 days/4-8 weeks, followed
by a 3-5 day prodrome of fever, malaise, and arthralgias.
Q: Symptoms of Mononucleosis, 🗹🗹: Fatigue may last for 1-2 months after
resolution of the infection. Rarely the lymph nodes and spleen will become enlarged
causing splenomegally 50% of the time.
Q: Leading cause of death from Mononucleosis, 🗹🗹: Splenic rupture is rare but can
occur and is the leading cause of death.
Q: Diagnostic Criteria for Mononucleosis, 🗹🗹: Diagnosis is based on Hoagland's
criteria of at least 50% lymphocytes and at least 10% atypical lymphocytes in the blood
in the presence of fever, pharyngitis, and adenopathy confirmed by a positive serologic
test. 5-15% of Monospot tests yield false-positive results.
Q: Mononucleosis Treatment, 🗹🗹: Is usually self-limiting, medical intervention is
rarely required. Treatment is supportive including rest, analgesics and antipyretics.
, Page | 2
Q: Mononucleosis Treatment, 🗹🗹: Ibuprofen, NOT ASPIRIN, is used in children and
adolescents due to reported incidence of Reye syndrome associated with EBV.
Ampicillin is contraindicated because it can cause a rash in most cases of IM. Bed rest
and avoidance of strenuous activity should be included, as well as steroids. Acyclovir
has been used in immunosuppressed individuals.
Q: Leukemia, 🗹🗹: an uncontrolled proliferation of malignant leukocytes, causing an
overcrowding of bone marrow and decreased production and function of normal
hematopoietic cells.
Q: Leukemia, 🗹🗹: classified by its predominant cell of origin (myeloid or lymphoid)
and the rate of progression (chronic or acute).
Q: Four types of Leukemia, 🗹🗹: Acute lymphocytic (ALL), acute myelogenous (AML),
chronic lymphocytic (CLL), and chronic myelogenous (CML).
Q: Leukemia, 🗹🗹: White children have higher rates of occurrence. ALL is the least
common overall but is the most common in children.
Q: Leukemia Patho, 🗹🗹: Blasts "crowd out" bone marrow and cause cellular
proliferation of the other cell lines to decrease, possibly resulting in pancytopenia
(reduction in all cellular components of blood).
Q: Acute Lymphocytic Leukemia, 🗹🗹: • most common childhood leukemia
• greater than 30% lymphoblasts in bone marrow or blood
• genetic anomaly - Philadelphia chromosome (between chromosomes 9 and 22)
• risk factors: prenatal x-ray exposure, postnatal exposure to high-dose radiation, viral
infections with HTLV-1 (can cause rare form of ALL and EBV), Down syndrome
, Page | 3
Q: Acute Myelogenous Leukemia, 🗹🗹: • most common adult leukemia
• Down syndrome increases risk
• caused by abnormal proliferation of myeloid precursor cells, decreased rate of
apoptosis, arrest in cellular differentiation, mutation in the receptor tyrosine kinase
FLT3
• risk factors include exposure to radiation, benzene, chemotherapy, hereditary
conditions
Q: Manifestations of Acute Leukemia, 🗹🗹: • fatigue from anemia
• bleeding from thrombocytopenia (reduced platelets)
• fever from infection
• anorexia, weight loss, diminished sensitivity to sweet and sour tastes, muscle wasting,
difficulty swallowing
• CNS involvement
Q: Treatment of Acute Leukemia, 🗹🗹: • chemotherapy
• supportive measures (blood transfusions, abx, antifungals, antivirals)
• allopurinol which prevents production of uric acid (which is elevated from cellular
death due to treatment)
• stem cell transplantation
• bone marrow transplant
Q: Complications of Acute Leukemia, 🗹🗹: • anemia (treatment: blood products)
• neutropenia (treatment: granulocyte colony-stimulated factor G-CSF or granulocyte
macrophage colony stimulating factor GM-CSF)
• low WBC count (treatment: colony-stimulating factors to prevent infections)
Q: Chronic Lymphocytic Leukemia, 🗹🗹: • affects monoclonal B lymphocytes
• has familial tendency
• is common in adults > 50 yrs
, Page | 4
Q: Chronic Myelogenous Leukemia, 🗹🗹: • usually diagnosed in adults
• is a meloproliferative disorder that also includes polycythemia vera, primary
thrombocytosis, and idiopathic myelofibrosis
• Philadelphia chromosome often present
Q: Manifestations of CLL, 🗹🗹: •advances slowly and insiduously
• asymptomatic at the time of diagnosis; lymphadenopathy is the most common finding;
suppresses humoral immunity, increases infection with encapsulated bacteria
Q: Manifestations of CML, 🗹🗹: • advances slowly and insiduously
infections, fever, weight loss; chronic phase (2-5 years, symptoms may not be
apparent); accelerated phase (6-18 months, primary symptom is splenomegaly);
terminal blast phase ("blast crisis", survival only 3-6 months)
Q: Treatment for Chronic Leukemia, 🗹🗹: • chlorambucil, administered with or
without corticosteroids, on a daily or intermittent schedule
• chemotherapy
• no cure for CML (combined chemotherapy, biologic response modifiers, allogenic stem
cell transplantation)
Q: Multiple Myeloma, 🗹🗹: A plasma cell malignancy and is a slow proliferating
cancer of the bone marrow. They secrete large amounts of proteins that resemble intact
immunoglobulins.
Q: Multiple Myeloma, 🗹🗹: Occurs about twice as much in blacks as in whites and
rarely occurs before the age of 40 with the peak being around 70.
Q: Manifestations of Multiple Myeloma, 🗹🗹: Hypercalcemia, renal failure,
Proteinuria, anemia, bone lesions, Confusion, headaches, and blurred vision. Destruction
of bone tissue causes pain, the most common presenting symptom.
Q: Monoclonal gammopathy of undetermined significance (MGUS), 🗹🗹: The M
protein is found in the blood urine without the presence of MM.
Pathophysiology NU545 Unit 4 Questions
and Answers (Expert Solutions)
Q: Infectious Mononucleosis, 🗹🗹: An acute, self-limiting viral infection of B cells,
most commonly caused Epstein - Barr Virus ( EBV) but can be caused by CMV,
adenovirus, hepatitis A, influenza A and B, rubella, bacteria toxoplasma gondii,
corynebacterium diptheriae, and coxiella burnetii.
Q: Infectious Mononucleosis triad of symptoms, 🗹🗹: Pharyngitis, lymphadenopathy,
fever
Q: Infectious Mononucleosis, 🗹🗹: Transmission is through saliva ("kissing disease")
and blood
Q: Incubation period Mononucleosis, 🗹🗹: Approx. 30-50 days/4-8 weeks, followed
by a 3-5 day prodrome of fever, malaise, and arthralgias.
Q: Symptoms of Mononucleosis, 🗹🗹: Fatigue may last for 1-2 months after
resolution of the infection. Rarely the lymph nodes and spleen will become enlarged
causing splenomegally 50% of the time.
Q: Leading cause of death from Mononucleosis, 🗹🗹: Splenic rupture is rare but can
occur and is the leading cause of death.
Q: Diagnostic Criteria for Mononucleosis, 🗹🗹: Diagnosis is based on Hoagland's
criteria of at least 50% lymphocytes and at least 10% atypical lymphocytes in the blood
in the presence of fever, pharyngitis, and adenopathy confirmed by a positive serologic
test. 5-15% of Monospot tests yield false-positive results.
Q: Mononucleosis Treatment, 🗹🗹: Is usually self-limiting, medical intervention is
rarely required. Treatment is supportive including rest, analgesics and antipyretics.
, Page | 2
Q: Mononucleosis Treatment, 🗹🗹: Ibuprofen, NOT ASPIRIN, is used in children and
adolescents due to reported incidence of Reye syndrome associated with EBV.
Ampicillin is contraindicated because it can cause a rash in most cases of IM. Bed rest
and avoidance of strenuous activity should be included, as well as steroids. Acyclovir
has been used in immunosuppressed individuals.
Q: Leukemia, 🗹🗹: an uncontrolled proliferation of malignant leukocytes, causing an
overcrowding of bone marrow and decreased production and function of normal
hematopoietic cells.
Q: Leukemia, 🗹🗹: classified by its predominant cell of origin (myeloid or lymphoid)
and the rate of progression (chronic or acute).
Q: Four types of Leukemia, 🗹🗹: Acute lymphocytic (ALL), acute myelogenous (AML),
chronic lymphocytic (CLL), and chronic myelogenous (CML).
Q: Leukemia, 🗹🗹: White children have higher rates of occurrence. ALL is the least
common overall but is the most common in children.
Q: Leukemia Patho, 🗹🗹: Blasts "crowd out" bone marrow and cause cellular
proliferation of the other cell lines to decrease, possibly resulting in pancytopenia
(reduction in all cellular components of blood).
Q: Acute Lymphocytic Leukemia, 🗹🗹: • most common childhood leukemia
• greater than 30% lymphoblasts in bone marrow or blood
• genetic anomaly - Philadelphia chromosome (between chromosomes 9 and 22)
• risk factors: prenatal x-ray exposure, postnatal exposure to high-dose radiation, viral
infections with HTLV-1 (can cause rare form of ALL and EBV), Down syndrome
, Page | 3
Q: Acute Myelogenous Leukemia, 🗹🗹: • most common adult leukemia
• Down syndrome increases risk
• caused by abnormal proliferation of myeloid precursor cells, decreased rate of
apoptosis, arrest in cellular differentiation, mutation in the receptor tyrosine kinase
FLT3
• risk factors include exposure to radiation, benzene, chemotherapy, hereditary
conditions
Q: Manifestations of Acute Leukemia, 🗹🗹: • fatigue from anemia
• bleeding from thrombocytopenia (reduced platelets)
• fever from infection
• anorexia, weight loss, diminished sensitivity to sweet and sour tastes, muscle wasting,
difficulty swallowing
• CNS involvement
Q: Treatment of Acute Leukemia, 🗹🗹: • chemotherapy
• supportive measures (blood transfusions, abx, antifungals, antivirals)
• allopurinol which prevents production of uric acid (which is elevated from cellular
death due to treatment)
• stem cell transplantation
• bone marrow transplant
Q: Complications of Acute Leukemia, 🗹🗹: • anemia (treatment: blood products)
• neutropenia (treatment: granulocyte colony-stimulated factor G-CSF or granulocyte
macrophage colony stimulating factor GM-CSF)
• low WBC count (treatment: colony-stimulating factors to prevent infections)
Q: Chronic Lymphocytic Leukemia, 🗹🗹: • affects monoclonal B lymphocytes
• has familial tendency
• is common in adults > 50 yrs
, Page | 4
Q: Chronic Myelogenous Leukemia, 🗹🗹: • usually diagnosed in adults
• is a meloproliferative disorder that also includes polycythemia vera, primary
thrombocytosis, and idiopathic myelofibrosis
• Philadelphia chromosome often present
Q: Manifestations of CLL, 🗹🗹: •advances slowly and insiduously
• asymptomatic at the time of diagnosis; lymphadenopathy is the most common finding;
suppresses humoral immunity, increases infection with encapsulated bacteria
Q: Manifestations of CML, 🗹🗹: • advances slowly and insiduously
infections, fever, weight loss; chronic phase (2-5 years, symptoms may not be
apparent); accelerated phase (6-18 months, primary symptom is splenomegaly);
terminal blast phase ("blast crisis", survival only 3-6 months)
Q: Treatment for Chronic Leukemia, 🗹🗹: • chlorambucil, administered with or
without corticosteroids, on a daily or intermittent schedule
• chemotherapy
• no cure for CML (combined chemotherapy, biologic response modifiers, allogenic stem
cell transplantation)
Q: Multiple Myeloma, 🗹🗹: A plasma cell malignancy and is a slow proliferating
cancer of the bone marrow. They secrete large amounts of proteins that resemble intact
immunoglobulins.
Q: Multiple Myeloma, 🗹🗹: Occurs about twice as much in blacks as in whites and
rarely occurs before the age of 40 with the peak being around 70.
Q: Manifestations of Multiple Myeloma, 🗹🗹: Hypercalcemia, renal failure,
Proteinuria, anemia, bone lesions, Confusion, headaches, and blurred vision. Destruction
of bone tissue causes pain, the most common presenting symptom.
Q: Monoclonal gammopathy of undetermined significance (MGUS), 🗹🗹: The M
protein is found in the blood urine without the presence of MM.
