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Zorluk: KolayInfectious Diseases

A 1919-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 77 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 38.4∘C38.4^\circ\text{C} (101.1∘F101.1^\circ\text{F}), blood pressure of 115/72 mm Hg115/72\text{ mm Hg}, pulse of 92/min92/\text{min}, and respirations of 14/min14/\text{min}. 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?

  1. Recommend rest, hydration, and nonsteroidal anti-inflammatory drugsCevap
  2. B
    Prescribe a course of oral ampicillin
  3. C
    Prescribe a course of oral clarithromycin
  4. D
    Administer a single dose of intramuscular ceftriaxone
  5. E
    Prescribe a course of oral valacyclovir

Cevap

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.

Adım Adım Çözüm

1
Analyze the clinical presentation and physical exam findings.
The patient presents with a classic triad of fever, tonsillar pharyngitis, and profound fatigue, alongside posterior cervical lymphadenopathy and splenomegaly.
Identifying these classic symptoms strongly points toward infectious mononucleosis rather than a bacterial pharyngitis (which typically presents with anterior cervical lymphadenopathy and no splenomegaly).
2
Interpret the diagnostic testing.
The heterophile antibody test (Monospot test) is positive.
A positive heterophile antibody test in the appropriate clinical context confirms the diagnosis of Epstein-Barr virus (EBV) infection.
3
Determine the most appropriate management based on the confirmed diagnosis.
Supportive care with rest, hydration, and NSAIDs is selected.
Because EBV is a viral illness, antimicrobial therapy is ineffective and inappropriate. Prescribing antibiotics violates stewardship principles and exposes the patient to adverse effects.

Anahtar Kavram

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.
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