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Nu 545- Unit 4 Study Guide Questions and Answers 2024 100% Perfect For Exam Prep
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Nu 545- Unit 4 Study GuideQuestions and Answers 2024 100%
Perfect For Exam Prep
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Infectious Mononucleosis p. 966
A benign, acute, self-limiting lymphoproliferative clinical syndrome characterized
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by acute viral infection of B lymphocytes (B cells). Associated with several
tumors, most commonly specific lymphomas and nasopharyngeal carcinoma. Most
common cause- EBV.
TU
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
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tract & blood. No aerosol transmission.
Disease begins with widespread infection of B lymphocytes which have receptors
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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.
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Patho of Infectious Mononucleosis p. 966
In the immunocompetent patient, unaffected B cells produce antibodies (IgG, IgM,
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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
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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
Lymphadenitis
,hepatitis
Splenitis
Pneumonitis
Meningitis
Encephalitis
Clinical manifestations of infectious mononucleosis p. 967
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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
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days.
At time of dx patient has classic triad of symptoms: fever, pharyngitis,
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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,
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demyelinating disease.
Ocular manifestations: eyelid/periorbital edema, dry eyes, keratitis, uveitis,
conjunctivitis, retinitis, oculoglandular syndrome, choroiditis, papillitis,
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ophthalmoplegia. In child: Reye syndrome
Pulmonary involvement: RARE- hilar and mediastinal lymphadenopathy,
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interstitial pneumonitis, pleural effusions, pneumonia and resp fail in
immunocompromised patient.
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Older patient with 2 weeks of temp that can't be explained EBV should be
suspected
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Eval and Tx of infectious mononucleosis p. 967
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.
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Leukemia p. 968
A clonal malignant disorder of leukocytes in the bone marrow and usually but not
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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 as well as proliferation disorder.
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Acute Leukemia p. 968
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Characterized by undifferentiated or immature cells, usually a blast cell, and the
onset of disease is abrupt and rapid with a short survival time.
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Chronic Leukemia p. 968
The predominant cell is more differentiated but does not function normally, with a
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relatively slow progression
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4 types of leukemia p. 968
Acute Lymphocytic (ALL)
Acute Myelogenous (ALM)
Chronic Lymphocytic (CLL)
Chronic Myelogenous (CML)
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