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NU 545 Unit 4 Questions and Answers
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
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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.
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
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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
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, 4 | Page
Ans: 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
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.
© 2025 All rights reserved
NU 545 Unit 4 Questions and Answers
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
© 2025 All rights reserved
, 2 | Page
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.
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
© 2025 All rights reserved
, 3 | Page
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
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, 4 | Page
Ans: 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
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.
© 2025 All rights reserved
