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Amoxicillin-clavulanate
3%
2/69
Heterophile antibody test
78%
54/69
Peripheral blood smear
0%
0/69
Supportive therapy
14%
10/69
Throat culture
Select Answer to see Preferred Response
This patient is presenting with fatigue, fever, an exudative pharyngitis, splenomegaly, and posterior cervical lymphadenopathy suggestive of infectious mononucleosis. In a patient with a classic presentation, the diagnosis can be made clinically and supportive therapy and rest are all that is needed. Infectious mononucleosis is commonly caused by the Epstein-Barr virus. It typically presents with fatigue, malaise, fever, posterior cervical lymphadenopathy, an exudative pharyngitis, and splenomegaly. In a patient presenting with classic signs and symptoms, diagnostic testing is not needed (though a rapid strep test may be performed to rule out streptococcal pharyngitis). The onset of symptoms of mononucleosis may be more insidious and chronic than streptococcal pharyngitis. Patients incorrectly diagnosed with streptococcal pharyngitis and treated with amoxicillin may develop a characteristic rash (which is not dangerous and will resolve with cessation of amoxicillin). A monospot test is often not positive at the onset of symptoms and is not a reliable test as it may be positive from previous episodes of mononucleosis; however, it may be performed in unclear cases. Treatment is supportive care and avoidance of contact sports to avoid splenic rupture. Figure A shows an exudative pharyngitis which can be seen in mononucleosis. Incorrect Answers: Answer 1: Amoxicillin-clavulanate is appropriate management of streptococcal pharyngitis; however, it would cause a characteristic rash if given to a patient who has a diagnosis of mononucleosis. Answer 2: Heterophile antibody test may be indicated in cases of mononucleosis that are uncertain. It is not regularly indicated and likely is not positive at this point given the patient has only had symptoms for 2 days. Answer 3: Peripheral blood smear may demonstrate an atypical lymphocyte which can be seen in mononucleosis; however, this is not a routine step in the management of mononucleosis. Answer 5: Throat culture may be indicated if the suspected diagnosis was a bacterial pharyngitis and a rapid strep test was negative; however, the most likely diagnosis in this patient is infectious mononucleosis and a throat culture is not needed. Bullet Summary: Infectious mononucleosis is a clinical diagnosis and can be managed with supportive therapy and avoidance of contact sports.
3.3
(14)
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