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Thread: 21-year-old woman presents with malaise, fever, and sore throat

  1. #1
    Join Date
    Dec 2006
    Mauritius (SSRMC)
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    Arrow 21-year-old woman presents with malaise, fever, and sore throat

    A 21-year-old woman presents with malaise, fever, and sore throat of four
    days’ duration. On physical examination, she is febrile (T 38.3 C), and bilateral
    exudates are noted in her pharynx. Anterior and posterior cervical adenopathy is
    noted. There is no nuchal rigidity. Lungs are clear and cardiac examination is normal.
    On examination of the abdomen, mild splenomegaly is noted. Laboratory
    examination shows transaminases to be two times the upper limit of normal. A
    complete blood count shows a normal hematocrit and platelet count; her lymphocyte
    count is mildly elevated with a predominance of atypical lymphocytes. The most
    likely cause of this patient’s clinical presentation is

    A. Group A β-hemolytic streptococcus
    B. Group D streptococcus
    C. Acute retroviral syndrome
    D. Epstein-Barr (EBV) infection
    E. Lymphoma

    Answer: D. This patient demonstrates the classic presentation of mononucleosis,
    due to infection with EBV. Patients with EBV commonly develop malaise, fevers,
    exudative pharyngitis, and lymphadenopathy. Additional findings may include
    splenomegaly, a mild elevation of transaminases, and a predominance of atypical
    lymphocytes. Bacterial infection would be unlikely to explain all the findings in this
    patient. Acute HIV infection, which may result in the acute retroviral syndrome, is
    not associated with exudative pharyngitis or splenomegaly. However, acute HIV
    infection should always be considered in a patient who presents with a viral
    syndrome. Lymphoma is much less common than EBV infection, and although it
    could explain much of this patient’s presentation, it would not be the most likely
    explanation for her presentation.[/hide]

  2. #2
    Join Date
    Oct 2007
    New Delhi
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    These all are symptoms of EBV
    nice mcq amal...looking for more..

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