Mononucleosis and Related Conditions Quiz
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Questions and Answers

Which of the following best describes the typical age range primarily affected by mononucleosis?

  • Adults over 40 years old
  • Young adults between 12 and 19 years old (correct)
  • Elderly individuals over 65 years old
  • Children under 10 years old

    • What is the primary route of transmission for mononucleosis?

  • Saliva and genital secretions (correct)
  • Contaminated food and water
  • Airborne droplets
  • Direct contact with skin lesions

    • What proportion of the adult population is estimated to have been affected by mononucleosis?

  • Approximately 25%
  • Approximately 95% (correct)
  • Approximately 50%
  • Approximately 75%

    • A common complication with mononucleosis causes a patient to develop an inflamed liver. What term correctly describes this condition?

    <p>Hepatitis</p> Signup and view all the answers

    In the context of treating mononucleosis, which of the following should be avoided because it may lead to a rash?

    <p>Ampicillin</p> Signup and view all the answers

    What is the primary etiology of olfactory dysfunction?

    <p>Anatomical blockage of the nasal cavity leading to airflow obstruction</p> Signup and view all the answers

    Which of the following is the most likely underlying cause of vasomotor rhinitis?

    <p>Increased sensitivity of the vidian nerve</p> Signup and view all the answers

    What is a common underlying condition associated with the development of nasal polyps?

    <p>Chronic inflammation and genetic factors</p> Signup and view all the answers

    Which of these factors do NOT contribute to the etiology of nasal polyps?

    <p>Unilateral septal deviation</p> Signup and view all the answers

    A patient presents with anosmia subsequent to a recent upper respiratory infection. Which etiology is most likely?

    <p>Transient nasal blockage due to the illness</p> Signup and view all the answers

    What is a common cause of clear rhinorrhea observed in elderly patients, which is most associated with vasomotor rhinitis?

    <p>Increased sensitivity of the vidian nerve</p> Signup and view all the answers

    How might anatomical abnormalities lead to symptoms of olfactory dysfunction?

    <p>By physically obstructing the airflow to the olfactory cleft</p> Signup and view all the answers

    What is NOT an identifiable cause of olfactory dysfunction?

    <p>Vidian nerve damage</p> Signup and view all the answers

    Which of the following is generally NOT recommended in the treatment of laryngitis?

    <p>Antibiotics</p> Signup and view all the answers

    In professional vocalists with laryngitis, what is a necessary step before PO/IM corticosteroids are administered?

    <p>ENT vocal cord visualization</p> Signup and view all the answers

    Which symptom, when present with laryngitis, should prompt an ENT referral?

    <p>Hemoptysis</p> Signup and view all the answers

    What differentiates laryngopharyngeal reflux (LPR) from typical gastroesophageal reflux disease (GERD)?

    <p>Only half of LPR patients have typical GERD symptoms.</p> Signup and view all the answers

    How is a diagnosis for Laryngopharyngeal reflux (LPR) typically made?

    <p>Positive response to PPI trial</p> Signup and view all the answers

    What is the typical time frame for symptom improvement in the larynx after starting treatment for laryngopharyngeal reflux (LPR)?

    <p>3-6 months</p> Signup and view all the answers

    Rheumatic fever is a systemic autoimmune process that typically develops following which condition?

    <p>Group A streptococcal pharyngitis</p> Signup and view all the answers

    Which specific valve is most commonly affected in patients with Rheumatic fever?

    <p>Mitral valve</p> Signup and view all the answers

    Which clinical manifestation is classified as a major Jones criteria for the diagnosis of acute rheumatic fever?

    <p>Erythema marginatum</p> Signup and view all the answers

    When is an echocardiogram needed, in a patient with suspected rheumatic fever?

    <p>All suspected cases of Rheumatic Fever</p> Signup and view all the answers

    Which of the following is the most common etiological agent for acute viral rhinosinusitis?

    <p>Rhinoviruses</p> Signup and view all the answers

    Besides rhinoviruses, which other viral family is frequently implicated in the etiology of acute viral rhinosinusitis?

    <p>Adenoviruses</p> Signup and view all the answers

    Based on the content, what is the primary characteristic of an individual's susceptibility to the viruses that cause acute rhinosinusitis?

    <p>One is susceptible for their entire life.</p> Signup and view all the answers

    What is NOT stated as a possible method of transmission for viruses that cause acute rhinosinusitis?

    <p>Vector-borne spread</p> Signup and view all the answers

    Which of the following is NOT mentioned as a potential sequelae or exacerbation caused by acute viral rhinosinusitis?

    <p>Exacerbation of chronic obstructive lung disease</p> Signup and view all the answers

    What is typically the duration for typical symptoms of an acute viral rhinosinusitis, before requiring further medical treatment?

    <p>Within 10 days</p> Signup and view all the answers

    What is the most common underlying factor contributing to the development of allergic rhinitis?

    <p>Genetic predisposition</p> Signup and view all the answers

    According to the content, what is the atopic triad?

    <p>Asthma, eczema, allergic rhinitis</p> Signup and view all the answers

    Which of these is NOT a common etiology of the common cold?

    <p>Pneumococcus</p> Signup and view all the answers

    Which environmental factor is MOST likely to cause year-round allergic rhinitis symptoms?

    <p>Exposure to dust and household mites</p> Signup and view all the answers

    What is a common complication mentioned related to acute rhinosinusitis?

    <p>Chronic sinusitis</p> Signup and view all the answers

    A patient presents with symptoms that worsen during specific times of the year. Which allergen is most likely the cause of the symptoms?

    <p>Seasonal pollens and spores</p> Signup and view all the answers

    Which of these is considered to be an etiology of allergic rhinitis?

    <p>Seasonal pollens</p> Signup and view all the answers

    Which of these is LEAST likely to trigger year-round symptoms of allergic rhinitis?

    <p>Exposure to seasonal plants</p> Signup and view all the answers

    A patient reports symptoms of allergic rhinitis worsening during spring and fall. Which of the following etiologies is MOST likely?

    <p>Seasonal pollen and spores</p> Signup and view all the answers

    A patient has year-round rhinitis symptoms. Which of these is LEAST likely to be a trigger?

    <p>Ragweed pollen</p> Signup and view all the answers

    Which factor plays a significant role in the etiology of both seasonal and year-round allergic rhinitis?

    <p>Exposure to environmental allergens</p> Signup and view all the answers

    Which of these statements regarding common allergens is accurate?

    <p>Dust and mites can cause year-round symptoms.</p> Signup and view all the answers

    Which of the following represents an environmental factor that would primarily trigger seasonal allergic rhinitis symptoms?

    <p>Exposure to seasonal pollens</p> Signup and view all the answers

    A patient is diagnosed with allergic rhinitis and the symptoms are not seasonal. Which environmental factor would be the MOST likely cause?

    <p>Dust and mites from within the home</p> Signup and view all the answers

    Viral rhinosinusitis is usually less than how many days?

    <p>10</p> Signup and view all the answers

    What is the primary etiology of acute bacterial rhinosinusitis?

    <p>S pneumoniae</p> Signup and view all the answers

    Which of the following are physical exam findings of acute bacterial rhinosinusitis? (Select all that apply)

    <p>Tenderness to palpation</p> Signup and view all the answers

    What is the first-line treatment for acute bacterial rhinosinusitis?

    <p>Amoxicillin-Clavulanate</p> Signup and view all the answers

    What is the first line treatment for bacterial rhinosinusitis in a patient with a penicillin allergy?

    <p>Doxycycline</p> Signup and view all the answers

    Which of the following are risk factors for allergic rhinitis? (Select all that apply)

    <p>Family history of allergies</p> Signup and view all the answers

    What is a common physical exam finding in patients with allergic rhinitis?

    <p>Pale, bluish mucosa</p> Signup and view all the answers

    What is cobblestoning in the back of the throat?

    <p>Hyperplastic lymphoid tissue</p> Signup and view all the answers

    A transverse nasal crease is also known as what?

    <p>Denny Morgan Line</p> Signup and view all the answers

    What is the mainstay treatment of allergic rhinitis?

    <p>Antihistamines</p> Signup and view all the answers

    Which of the following are two types of allergenic testing? (Select all that apply)

    <p>Immunoassay for IgE</p> Signup and view all the answers

    Vasomotor rhinitis is caused by which of the following?

    <p>Increased sensitivity to vidian nerve</p> Signup and view all the answers

    What is hyposmia?

    <p>Reduced ability to smell</p> Signup and view all the answers

    What is anosmia?

    <p>Loss of smell</p> Signup and view all the answers

    What is one possible etiology of olfactory dysfunction?

    <p>All of the above</p> Signup and view all the answers

    What are nasal polyps?

    <p>Small, non-cancerous growths on the lining of the nasal passages</p> Signup and view all the answers

    What is Samter's triad?

    <p>Asthma, aspirin sensitivity, and nasal polyps</p> Signup and view all the answers

    What are key physical exam findings associated with nasal polyps?

    <p>Pale, Edematous, glistening mass</p> Signup and view all the answers

    What key test is indicated in children with nasal polyps?

    <p>Sweat chloride test</p> Signup and view all the answers

    Which of the following is a bacterial etiology of pharyngitis?

    <p>Group A Beta Hemolytic Streptococcal</p> Signup and view all the answers

    Group A Beta Hemolytic Strep can progress to?

    <p>Rheumatic fever</p> Signup and view all the answers

    Which of the following symptoms are commonly indicative of a Group A Streptococcus (Strep A) infection? (Select all that apply)

    <p>Fever</p> Signup and view all the answers

    Which of the following are physical exam findings of Group A Streptococcal infection? (Select all that apply)

    <p>Tender Cervical Lymphadenopathy</p> Signup and view all the answers

    What is the first line treatment for Streptococcal infections?

    <p>IM Penicillin</p> Signup and view all the answers

    Which of the following can cause laryngitis? (Select all that apply)

    <p>Viral</p> Signup and view all the answers

    What is laryngopharyngeal reflux?

    <p>The backflow of stomach contents into the throat and larynx</p> Signup and view all the answers

    Which of the following are symptoms of Laryngopharyngeal reflux? (Select all that apply)

    <p>Chronic cough</p> Signup and view all the answers

    What is Rheumatic fever?

    <p>Systemic autoimmune process that occurs 2-4 weeks post GABHS</p> Signup and view all the answers

    Which of the following are considered the major Jones criteria for diagnosing rheumatic fever? (Select all that apply)

    <p>Arthritis</p> Signup and view all the answers

    What is chronic rheumatic fever typically characterized by?

    <p>Persistent inflammation of the heart and joints</p> Signup and view all the answers

    What is erythema marginatum?

    <p>A type of skin rash characterized by circular red spots with pale centers</p> Signup and view all the answers

    What is chorea?

    <p>Involuntary and uncoordinated movements of face, tongue, upper extremities</p> Signup and view all the answers

    Which of the following are considered minor Jones criteria? (Select all that apply)

    <p>Arthralgia</p> Signup and view all the answers

    What is the most common treatment for rheumatic fever?

    <p>Antibiotics</p> Signup and view all the answers

    What is the primary cause of mononucleosis?

    <p>Epstein-Barr virus</p> Signup and view all the answers

    How does mononucleosis typically present on physical examination?

    <p>All of the above</p> Signup and view all the answers

    Which of the following tests is commonly used for the diagnosis of mononucleosis?

    <p>Heterophile agglutination test</p> Signup and view all the answers

    What is a common treatment approach for Mononucleosis?

    <p>Rest and hydration</p> Signup and view all the answers

    Which antibiotic should be avoided in patients with Mononucleosis?

    <p>Amoxicillin</p> Signup and view all the answers

    Study Notes

    Clinical Medicine II: Disorders of the Nose, Sinus, Pharynx, and Larynx

    • Objectives include summarizing the etiology, pathophysiology, clinical features, diagnostic methods, potential complications, and treatment for various conditions.

    • Conditions to be studied include acute rhinosinusitis (viral and bacterial), chronic sinusitis, allergic rhinitis, vasomotor rhinitis, olfactory dysfunction, and nasal polyps.

    • Allergy testing indications and management are also part of the objectives.

    • Viral pharyngitis, streptococcal infection, laryngitis, laryngopharyngeal reflux, acute and chronic hoarseness, rheumatic fever, and mononucleosis are also listed as conditions to be studied.

    Acute Viral Rhinosinusitis

    • Etiology: Numerous viruses (rhinoviruses, adenoviruses, etc.)

    • Susceptibility: Lifelong

    • Nature: Benign and self-limiting, but can lead to or exacerbate chronic conditions.

    • Transmission: Three forms: droplet, airborne (particles < 5 microns), and airborne (particles > 5 microns).

    • Diagnosis: Symptoms (sore throat, nasal congestion, rhinorrhea, hyposmia, associated malaise, headache, cough, conjunctivitis), duration (<10 days), physical exam (erythematous, engorged nasal mucosa with watery discharge, no purulence).

    • Differential Diagnosis: Purulence-absent diagnosis.

    • Treatment: Supportive care (NSAIDs, hypertonic saline nasal irrigation, oral decongestants, nasal spray decongestants (oxymetazoline or phenylephrine). Avoid antibiotics, antihistamines, and antivirals and Zinc, Honey, Echinacea, Vitamin C, and herbal supplements have unclear benefits.

    Acute Bacterial Rhinosinusitis

    • Characteristics: Less common than viral

    • Pathophysiology: Impaired mucociliary clearance, nasal mucosa inflammation, and obstruction

    • Etiology: S. pneumoniae, H. influenza, other streptococci, less commonly S. aureus & Moraxella catarrhalis.

    • Diagnosis: Tenderness to palpation of affected sinuses (maxillary sinus most common), non-contrast coronal CT scan if infection spreads beyond nasal cavity.

    • Treatment: NSAIDs, hypertonic saline nasal irrigation, nasal decongestants for symptom management, intranasal corticosteroids, and oral decongestants. Consider antibiotics if symptoms last more than 10 days or are severe (>10 days), amoxicillin-clavulanate first line. PCN allergic pts may need doxycycline or clindamycin + cephalosporin. ENT referral if it does not resolve or there are concerns.

    Chronic Sinusitis

    • Symptoms: last longer than 12 weeks
    • Diagnosis: CT scan and ENT referral.

    Allergic Rhinitis

    • Also known as "hay fever."
    • Prevalence: 20-30% in adults, up to 40% in children.
    • Family history: Often in patients with a family history of atopic disease.
    • Etiology: Seasonal pollens/spores; year-round sources include dust, household mites, air pollution, and pet dander.
    • Symptoms: Clear rhinorrhea, sneezing, tearing, eye irritation, pruritus, associated postnasal drip, cough, bronchospasm, skin conditions like eczema.
    • Diagnosis: Physical findings include pale bluish nasal mucosa, turbinate edema, clear rhinorrhea (possibly dripping down the posterior pharynx), and other physical symptoms.
    • Treatment: Intranasal corticosteroids (may take 2 weeks for improvement), antihistamines (non-sedating), adjunctive therapies (antileukotrienes - montelukast, intranasal anticholinergics), and allergen avoidance (plastic coverings for mattresses, synthetic materials for animal products, removal of dust surfaces, high-efficiency particulate air filters in rooms, and controlling sources of allergens).

    Olfactory Dysfunction (hyposmia or anosmia)

    • Etiology: Most commonly, anatomical blockage of airflow in the nasal cavity (polyps, septal abnormalities, tumors), or transient blockage with illnesses or allergies.

    • Diagnosis: Symptoms (reduced or absent sense of smell/taste), physical examination for visible obstruction (polyps, foreign body, trauma, mass), and olfactory testing by an ENT (may include gross scent evaluation).

    • Treatment: No specific treatment, some cases resolve spontaneously, patient education (food seasoning, smoke alarms, avoidance of gas appliances).

    Nasal Polyps

    • Benign growths in the nose or sinuses.

    • Pathophysiology: Likely inflammation and genetic factors.

    • Associated conditions: Asthma, aspirin allergy, cystic fibrosis, allergic rhinitis, chronic sinusitis.

    • Samter's triad: Possible association of asthma, aspirin sensitivity, and nasal polyps.

    • Diagnosis: Symptoms (nasal congestion, rhinorrhea, anosmia), physical examination showing pale, edematous, glistening mass in the nasal cavity overlaid with mucosa,

    • Treatment: Sweat chloride test for all children, glucocorticoids for management, and short-term oral corticosteroids and surgical excision if necessary.

    Pharyngitis (Sore Throat):

    • Differentiating viral from bacterial (group A beta-hemolytic streptococcal) infections is essential.

    • Viral pharyngitis (most common): Viral pathogens (rhinovirus, coronaviruses, influenza and parainfluenza, adenovirus, EBV, coxsackievirus, RSV, HSV).

    • Symptoms: General symptoms (gradual onset, sore throat, fever, cough, rhinorrhea, nasal congestion, hoarseness, fatigue, malaise, myalgia), without exudates.

    • Diagnosis: Primarily clinical. Testing for specific pathogens is typically not needed unless symptoms suggest a specific etiology.

    • Treatment: Supportive care (analgesics/antipyretics, hydration, throat lozenges/honey, rest), avoiding antibiotics.

    • Bacterial pharyngitis: Group A beta-hemolytic streptococcal (GABHS) and other pathogens (gonorrhea, mycoplasma, chlamydia).

    • Symptoms: Sore throat, pain, fever over 38.5C, absence of cough, exudates.

    • Diagnosis: Use of criteria (e.g. MDCalc Modified Criteria) and rapid antigen tests, followed by throat cultures.

    • Treatment: For GABHS, IM penicillin (if compliance is a concern), PO penicillin, or macrolides for penicillin allergies and supportive care.

    Laryngitis

    • Most common cause of hoarseness.

    • Can persist for a week after other symptoms resolve.

    • Etiologies: Viral (most common), bacterial infections like M. catarrhalis, H. influenzae, or S. pneumo.

    • Symptoms: Vocal hoarseness, breathiness, vocal fatigue often associated with other URI (Upper Respiratory Infection) sxs.

    • Diagnosis: Vocal quality, complete HEENT (Head, Eye, Ear, Nose, Throat) exam, assess cranial nerve function and respiration.

    • Treatment: Supportive care (fluids, humidified air), mucolytics, anti-reflux medication, NSAIDS, Antibiotics not generally needed; PO/IM steroids are only for professional vocalists needing vocal cord visualization by ENT.

    Laryngopharyngeal Reflux

    • Gastroesophageal reflux into the larynx.

    • Diagnosis: After excluding other hoarseness etiologies (e.g., tumor) via laryngoscopy.

    • Only half of patients display typical GERD symptoms.

    • Symptoms: Hoarseness, throat irritation, chronic cough, associated postnasal drip, throat clearing, esophageal spasm, and asthma.

    • Diagnosis: Symptoms typically worsen when standing upright and benefit from laryngoscopy evaluation by an ENT.

    • Treatment: Empiric trial of proton pump inhibitors (PPIs). Diagnostic measures include laryngoscopy and symptom response to PPIs over 3–6 months. If therapy fails, other etiologies are considered. Non-responders may need further testing (pH testing, manometry).

    Rheumatic Fever

    • Systemic autoimmune process.

    • Occurs 2-4 weeks after group A streptococcal pharyngitis (GABHS).

    • More common in developing countries.

    • Peak age: 5-15 years.

    • Mortality: 1–2% but can be 30% in patients with uncontrolled carditis.

    • Diagnosis: Identifying specific criteria (Jones criteria). Minor and major criteria must be assessed to diagnose.

    • Major criteria include carditis (pericarditis, cardiomegaly, heart failure, mitral regurgitation, need for echocardiography). Erythema marginatum (rapidly increasing macules, rings, or crescents), subcutaneous nodules (small, firm, nontender in children), chorea (involuntary movements of face, tongue, and upper extremities), and polyarthritis (migratory, involving large joints).

    • Minor criteria include polyarthralgia (joint pain without inflammation) fever, elevated acute phase reactants (ESR & CRP). Elevated ESR & CRP must be ≥60mm/hour & ≥3mg/dL. The PR interval in the ECG can also be a diagnostic indicator.

    • Treatment: Strict bed rest until afebrile, normal ESR/EKG, NSAIDs for fever and joint pain, and Penicillin IM to eradicate strep infection to prevent recurrence (PCN x at least 5 years) needed for treatment.

    Mononucleosis

    • Etiology: Viral infection, mainly affecting young adults (12–19 years).

    • Pathogens: Epstein-Barr virus (EBV), affects 95% of the adult population.

    • Symptoms: Typically include fever, malaise, sore throat, anorexia, myalgia, early and marked discrete posterior chain lymphadenopathy, splenomegaly (50% of patients), upper lid edema (Hoagland sign), and tonsillar exudate, palatine petechiae, maculopapular rash.

    • Diagnosis: Elevated levels of lymphocytes in the tonsils, lymphocytic leukocytosis and heterophile-antibody test (Monospot), and anti-EBV titer.

    • Treatment: Supportive care (NSAIDs, acetaminophen, throat gargles, rest, and hydration), and avoidance of extreme physical activity to prevent complications like hepatitis, myocarditis, neuropathy, encephalitis, airway obstruction, hemolytic anemia, or thrombocytopenia. Avoid antibiotics and PCN allergies should be considered.

    Review

    • How to differentiate bacterial versus viral rhinosinusitis.

    • Viral versus streptococcal pharyngitis.

    • Jones major/minor criteria for diagnosing rheumatic fever.

    • Lab evaluation for mononucleosis diagnosis.

    • Questions are welcomed.

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    Description

    This quiz assesses your knowledge about mononucleosis, its transmission, complications, and related respiratory conditions like olfactory dysfunction and nasal polyps. Answer questions about the typical age range affected, common causes, and treatment considerations to test your understanding of these medical topics.

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