A 22-year-old female graduate student at William and Mary College went to the infirmary complaining of a sore throat and difficulty swallowing. She had been feeling tired and "achy" for about 10 days. Her temperature was 100 and her throat was red with an exudate. Her tonsils were swollen and touched at mid-line.
Question 1 - Single Best Answer
What are the most common causes of sore throat/pharyngitis?
A) respiratory viruses
B) sexually transmitted bacteria
C) mycoplasma
D) Gram positive bacteria
E) normal oral flora
Question 2 - Single Best Answer
What are the three most common bacterial causes of sore throat?
A) Streptococcus, Staphylococcus, and Bordetella
B) Streptococcus, Staphylococcus, and Corynebacteria
C) Streptococcus, Corynebacteria, and Neisseria
D) Bordetella, Corynebacteria, Clostridia
E) Neisseria, Corynebacteria, Clostridia
Question 3 - Single Best Answer
How would you test for a bacterial cause for her sore throat?
A) serology
B) throat swab and culture on McConkey's or EMB agar
C) monospot test
D) throat swab and culture on blood agar
E) none of the above
Palpation of her lymph nodes showed that her cervical nodes were enlarged as were her axillary nodes. Splenomegaly was also present.
Question 4 - Single Best Answer
What does the lymphadenopathy and splenomegaly in a young adult with sore throat suggest?
A) Streptococcus pyogenes infection
B) diphtheria
C) infectious mononucleosis
D) rhinovirus infection
E) influenza virus infection
Question 5 - Single Best Answer
What is/are the viral causes of infectious mononucleosis?
A) Epstein-Barr virus
B) Cytomegalovirus
C) B19 virus
D) A and B
Question 6 - Single Best Answer
What family of viruses do CMV and EBV belong to?
A) Initialviridae
B) Hepadnaviridae
C) Herpesviridae
D) Orthomyxoviridae
E) Paramyxoviridae
Question 7 - Single Best Answer
Which of the following also belongs to the Herpes family?
A) measles virus
B) rubella virus
C) varicella (chicken pox)
D) variola
E) Neisseria
Question 8 - Single Best Answer
What is one common pathogenic mechanism that all Herpes viruses have?
A) anti-interferon RNA
B) endotoxin
C) antigenic variation
D) latency
E) capsule
Question 9 - Single Best Answer
What is a non-viral cause of a mononucleosis type syndrome?
A) B19
B) rickettsia
C) Streptococcus
D) toxoplasma
E) varicella
Question 10 - Single Best Answer
Getting back to your patient, what tests would you order first to best help her?
A) CBC and throat culture
B) CBC and liver enzymes
C) Liver enzymes and throat culture
D) viral serology
E) chest x-ray and liver enzymes
Question 11 - Single Best Answer
Why would you order a throat culture if you thought she had mononucleosis?
A) Viral mononucleosis is exacerbated by Streptococcus pyogenes
B) Rheumatic fever is more common after a Strep throat in people with mononucleosis
C) Mononucleosis is diagnosed with a throat culture
D) Strep throat can co-exist with mononucleosis
E) Toxoplasmosis can be ruled out with a throat culture
Question 12 - Single Best Answer
Why is it so important to diagnose a Streptococcal sore throat?
A) because it can be cured with antibiotics
B) because a non-suppurative sequela can be prevented with antibiotics
C) because it can be an antecedent to viral pneumonia
D) Strep throat is a reportable communicable disease
Her CBC showed a hematocrit of 45% and a WBC count of 12,000 (per sq mm) with 30% neutrophils, 29% lymphocytes, 21% atypical lymphocytes, and 20% monocytes. There were no beta-hemolytic colonies on the blood agar plate from her throat swab. Liver enzyme levels were also measured and were found to be elevated.Normal Lab Values
Question 13 - Single Best Answer
Which of the findings is the "hallmark" of infectious mononucleosis?
A) the low hematocrit
B) the throat culture
C) the high white count
D) the atypical lymphcytes
Question 14 - Single Best Answer
How would you confirm a diagnosis of acute EBV mononucleosis?
A) anti-EBV IgG (+)
B) heterophile antibody (-)
C) heterophile antibody (+)
D) culture the virus
E) culture immortal B lymphocytes
Her heterophile antibodies were positive.
Question 15 - Single Best Answer
What do you think the most likely diagnosis is at this point?
A) Streptococcal pharyngitis caused by non-hemolytic streptococci
B) EBV mononucleosis
C) viral hepatitis
D) toxoplasmosis
E) CMV mononucleosis
Question 16 - Single Best Answer
What therapy would you institute for this patient?
A) aspirin and rest
B) penicillin
C) interferon
D) acyclovir
E) amantadine
Question 17 - Single Best Answer
How did she get mono?
A) raw oysters
B) sexual transmission
C) bug bite
D) saliva
E) respiratory route
Question 18 - Single Best Answer
What other diseases does EBV cause?
A) Burkitt's lymphoma
B) nasopharyngeal carcinoma
C) oral hairy leukoplakia (OHL)
D) all of the above
