PATHOPHYSIOLOGY NU545 UNIT 4 EXAM
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS
Infectious Mononucleosis
An acute, self-limiting viral infection of B cells, most commonly caused Epstein - Barr Virus ( EBV) but can
be caused by CMV, adenovirus, hepatitis A, influenza A and B, rubella, bacteria toxoplasma gondii,
corynebacterium diptheriae, and coxiella burnetii.
Infectious Mononucleosis triad of symptoms
Pharyngitis, lymphadenopathy, fever
Infectious Mononucleosis
Transmission is through saliva ("kissing disease") and blood
Incubation period Mononucleosis
Approx. 30-50 days/4-8 weeks, followed by a 3-5 day prodrome of fever, malaise, and arthralgias.
Symptoms of Mononucleosis
Fatigue may last for 1-2 months after resolution of the infection. Rarely the lymph nodes and spleen will
become enlarged causing splenomegally 50% of the time.
Leading cause of death from Mononucleosis
,Splenic rupture is rare but can occur and is the leading cause of death.
Diagnostic Criteria for Mononucleosis
Diagnosis is based on Hoagland's criteria of at least 50% lymphocytes and at least 10% atypical
lymphocytes in the blood in the presence of fever, pharyngitis, and adenopathy confirmed by a positive
serologic test. 5-15% of Monospot tests yield false-positive results.
Mononucleosis Treatment
Is usually self-limiting, medical intervention is rarely required. Treatment is supportive including rest,
analgesics and antipyretics.
Mononucleosis Treatment
Ibuprofen, NOT ASPIRIN, is used in children and adolescents due to reported incidence of Reye syndrome
associated with EBV. Ampicillin is contraindicated because it can cause a rash in most cases of IM. Bed
rest and avoidance of strenuous activity should be included, as well as steroids. Acyclovir has been used
in immunosuppressed individuals.
Leukemia
an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and
decreased production and function of normal hematopoietic cells.
Leukemia
classified by its predominant cell of origin (myeloid or lymphoid) and the rate of progression (chronic or
acute).
Four types of Leukemia
,Acute lymphocytic (ALL), acute myelogenous (AML), chronic lymphocytic (CLL), and chronic myelogenous
(CML).
Leukemia
White children have higher rates of occurrence. ALL is the least common overall but is the most common
in children.
Leukemia Patho
Blasts "crowd out" bone marrow and cause cellular proliferation of the other cell lines to decrease,
possibly resulting in pancytopenia (reduction in all cellular components of blood).
Acute Lymphocytic Leukemia
• most common childhood leukemia
• greater than 30% lymphoblasts in bone marrow or blood
• genetic anomaly - Philadelphia chromosome (between chromosomes 9 and 22)
• risk factors: prenatal x-ray exposure, postnatal exposure to high-dose radiation, viral infections with
HTLV-1 (can cause rare form of ALL and EBV), Down syndrome
Acute Myelogenous Leukemia
• most common adult leukemia
• Down syndrome increases risk
• caused by abnormal proliferation of myeloid precursor cells, decreased rate of apoptosis, arrest in
cellular differentiation, mutation in the receptor tyrosine kinase FLT3
• risk factors include exposure to radiation, benzene, chemotherapy, hereditary conditions
Manifestations of Acute Leukemia
, • fatigue from anemia
• bleeding from thrombocytopenia (reduced platelets)
• fever from infection
• anorexia, weight loss, diminished sensitivity to sweet and sour tastes, muscle wasting, difficulty
swallowing
• CNS involvement
Treatment of Acute Leukemia
• chemotherapy
• supportive measures (blood transfusions, abx, antifungals, antivirals)
• allopurinol which prevents production of uric acid (which is elevated from cellular death due to
treatment)
• stem cell transplantation
• bone marrow transplant
Complications of Acute Leukemia
• anemia (treatment: blood products)
• neutropenia (treatment: granulocyte colony-stimulated factor G-CSF or granulocyte macrophage
colony stimulating factor GM-CSF)
• low WBC count (treatment: colony-stimulating factors to prevent infections)
Chronic Lymphocytic Leukemia
• affects monoclonal B lymphocytes
• has familial tendency
• is common in adults > 50 yrs
QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS
Infectious Mononucleosis
An acute, self-limiting viral infection of B cells, most commonly caused Epstein - Barr Virus ( EBV) but can
be caused by CMV, adenovirus, hepatitis A, influenza A and B, rubella, bacteria toxoplasma gondii,
corynebacterium diptheriae, and coxiella burnetii.
Infectious Mononucleosis triad of symptoms
Pharyngitis, lymphadenopathy, fever
Infectious Mononucleosis
Transmission is through saliva ("kissing disease") and blood
Incubation period Mononucleosis
Approx. 30-50 days/4-8 weeks, followed by a 3-5 day prodrome of fever, malaise, and arthralgias.
Symptoms of Mononucleosis
Fatigue may last for 1-2 months after resolution of the infection. Rarely the lymph nodes and spleen will
become enlarged causing splenomegally 50% of the time.
Leading cause of death from Mononucleosis
,Splenic rupture is rare but can occur and is the leading cause of death.
Diagnostic Criteria for Mononucleosis
Diagnosis is based on Hoagland's criteria of at least 50% lymphocytes and at least 10% atypical
lymphocytes in the blood in the presence of fever, pharyngitis, and adenopathy confirmed by a positive
serologic test. 5-15% of Monospot tests yield false-positive results.
Mononucleosis Treatment
Is usually self-limiting, medical intervention is rarely required. Treatment is supportive including rest,
analgesics and antipyretics.
Mononucleosis Treatment
Ibuprofen, NOT ASPIRIN, is used in children and adolescents due to reported incidence of Reye syndrome
associated with EBV. Ampicillin is contraindicated because it can cause a rash in most cases of IM. Bed
rest and avoidance of strenuous activity should be included, as well as steroids. Acyclovir has been used
in immunosuppressed individuals.
Leukemia
an uncontrolled proliferation of malignant leukocytes, causing an overcrowding of bone marrow and
decreased production and function of normal hematopoietic cells.
Leukemia
classified by its predominant cell of origin (myeloid or lymphoid) and the rate of progression (chronic or
acute).
Four types of Leukemia
,Acute lymphocytic (ALL), acute myelogenous (AML), chronic lymphocytic (CLL), and chronic myelogenous
(CML).
Leukemia
White children have higher rates of occurrence. ALL is the least common overall but is the most common
in children.
Leukemia Patho
Blasts "crowd out" bone marrow and cause cellular proliferation of the other cell lines to decrease,
possibly resulting in pancytopenia (reduction in all cellular components of blood).
Acute Lymphocytic Leukemia
• most common childhood leukemia
• greater than 30% lymphoblasts in bone marrow or blood
• genetic anomaly - Philadelphia chromosome (between chromosomes 9 and 22)
• risk factors: prenatal x-ray exposure, postnatal exposure to high-dose radiation, viral infections with
HTLV-1 (can cause rare form of ALL and EBV), Down syndrome
Acute Myelogenous Leukemia
• most common adult leukemia
• Down syndrome increases risk
• caused by abnormal proliferation of myeloid precursor cells, decreased rate of apoptosis, arrest in
cellular differentiation, mutation in the receptor tyrosine kinase FLT3
• risk factors include exposure to radiation, benzene, chemotherapy, hereditary conditions
Manifestations of Acute Leukemia
, • fatigue from anemia
• bleeding from thrombocytopenia (reduced platelets)
• fever from infection
• anorexia, weight loss, diminished sensitivity to sweet and sour tastes, muscle wasting, difficulty
swallowing
• CNS involvement
Treatment of Acute Leukemia
• chemotherapy
• supportive measures (blood transfusions, abx, antifungals, antivirals)
• allopurinol which prevents production of uric acid (which is elevated from cellular death due to
treatment)
• stem cell transplantation
• bone marrow transplant
Complications of Acute Leukemia
• anemia (treatment: blood products)
• neutropenia (treatment: granulocyte colony-stimulated factor G-CSF or granulocyte macrophage
colony stimulating factor GM-CSF)
• low WBC count (treatment: colony-stimulating factors to prevent infections)
Chronic Lymphocytic Leukemia
• affects monoclonal B lymphocytes
• has familial tendency
• is common in adults > 50 yrs
