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PATHOPHYSIOLOGY NU545 UNIT 4 EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS
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PATHOPHYSIOLOGY NU545 UNIT 4 EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS 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 tox...

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PATHOPHYSIOLOGY NU545 UNIT 4 EXAM

QUESTIONS AND ANSWERS WITH COMPLETE

SOLUTIONS
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.


Infectious Mononucleosis triad of symptoms


Pharyngitis, lymphadenopathy, fever


Infectious Mononucleosis


Transmission is through saliva ("kissing disease") and blood


Incubation period Mononucleosis


Approx. 30-50 days/4-8 weeks, followed by a 3-5 day prodrome of fever, malaise, and arthralgias.


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.


Leading cause of death from Mononucleosis

,Splenic rupture is rare but can occur and is the leading cause of death.


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.


Mononucleosis Treatment


Is usually self-limiting, medical intervention is rarely required. Treatment is supportive including rest,

analgesics and antipyretics.


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.


Leukemia


an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and

decreased production and function of normal hematopoietic cells.


Leukemia


classified by its predominant cell of origin (myeloid or lymphoid) and the rate of progression (chronic or

acute).


Four types of Leukemia

,Acute lymphocytic (ALL), acute myelogenous (AML), chronic lymphocytic (CLL), and chronic myelogenous

(CML).


Leukemia


White children have higher rates of occurrence. ALL is the least common overall but is the most common

in children.


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).


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


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


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


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


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)


Chronic Lymphocytic Leukemia


• affects monoclonal B lymphocytes

• has familial tendency

• is common in adults > 50 yrs

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