A -year-old male college student presents to the student health clinic complaining of a severely painful throat, subjective fevers, and profound exhaustion that has progressively worsened over the past days. He notes that he has been too tired to attend his classes. He has no chronic medical conditions and takes no daily medications. Vital signs show a temperature of (), blood pressure of , pulse of , and respirations of . Physical examination demonstrates marked bilateral posterior cervical lymphadenopathy, erythematous tonsils with grayish-white exudates, and mild splenomegaly. A point-of-care heterophile antibody test yields a positive result. Which of the following is the most appropriate management for this patient?
- Recommend rest, hydration, and nonsteroidal anti-inflammatory drugsAnswer
- BPrescribe a course of oral ampicillin
- CPrescribe a course of oral clarithromycin
- DAdminister a single dose of intramuscular ceftriaxone
- EPrescribe a course of oral valacyclovir
Answer
Recommend rest, hydration, and nonsteroidal anti-inflammatory drugs
The patient's presentation of fever, pharyngitis, posterior cervical lymphadenopathy, splenomegaly, and a positive heterophile antibody test confirms the diagnosis of infectious mononucleosis caused by the Epstein-Barr virus. Management of uncomplicated mononucleosis is strictly supportive. Patients should be advised to rest, maintain adequate hydration, and use over-the-counter analgesics/antipyretics such as nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom control. Additionally, they should be counseled to avoid contact sports for at least 3-4 weeks to prevent splenic rupture.
Step-by-Step Solution
Key Concept
The management of uncomplicated infectious mononucleosis is supportive; antibiotics must be avoided to adhere to stewardship principles and prevent adverse reactions such as ampicillin-induced rash.