EBV Flashcards
- T/F: Epstein-Barr virus (EBV) is a single-stranded RNA virus.
False. EBV is a double-stranded DNA virus belonging to the gammaherpesvirus family.
T/F: EBV infection always results in symptomatic infectious mononucleosis.
False. Many EBV infections are asymptomatic, especially in children.
T/F: Infectious mononucleosis can be caused by pathogens other than EBV.
True. Cytomegalovirus, Toxoplasma gondii, adenovirus, hepatitis viruses, and HIV can also cause infectious mononucleosis–like illness.
T/F: EBV is primarily transmitted through respiratory droplets in the air.
False. EBV is mainly transmitted through oral secretions (saliva), not airborne transmission.
T/F: EBV can be shed intermittently for life in infected individuals.
True. After the acute infection, EBV can be intermittently shed in oral secretions for life.
T/F: Nonintimate contact and fomites are major contributors to EBV transmission.
False. EBV does not spread significantly through nonintimate contact or fomites.
T/F: In developing countries, EBV infection commonly occurs during infancy and early childhood.
True. In developing countries, most children are infected by 3 years of age.
T/F: Infectious mononucleosis primarily affects children under 4 years of age.
False. Symptomatic infectious mononucleosis is rare in children under 4 years; it is more common in adolescents and young adults.
T/F: After initial infection, EBV primarily infects only B lymphocytes.
False. EBV infects both oral epithelial cells and tonsillar B lymphocytes.
T/F: The clinical symptoms of infectious mononucleosis are mainly due to the virus itself.
False. Symptoms result from the host immune response, not direct viral damage.
T/F: The incubation period of EBV infection before symptoms appear is about six weeks.
True. EBV has an incubation period of approximately 6 weeks before symptom onset.
T/F: Atypical lymphocytes in infectious mononucleosis are primarily CD8 T cells.
True. The atypical lymphocytes seen in blood smears are mainly activated CD8 T cells.
T/F: Natural killer (NK) cells do not play a significant role in EBV infection.
False. NK cells, especially CD56 dim CD16− NK cells, are important in recognizing and attacking EBV-infected cells.
T/F: The body can completely eliminate EBV after infection.
False. EBV establishes lifelong latent infection in memory B lymphocytes.
T/F: EBV remains dormant after the primary infection and does not reactivate.
False. EBV can reactivate, leading to intermittent viral shedding in oral secretions.
T/F: EBV integrates into the host cell genome as part of its latent infection.
False. Unlike some viruses, EBV persists as an episome in the nucleus rather than integrating into the host genome.
T/F: During latency, only a few viral proteins are produced.
True. EBV nuclear antigens (EBNAs) help maintain the viral episome during the latent phase.
T/F: Reactivation of EBV is often associated with noticeable clinical symptoms.
False. Reactivation usually occurs without significant symptoms in most people.
T/F: The incubation period of infectious mononucleosis in adolescents is between 30-50 days.
True. The incubation period in adolescents and adults typically lasts 30-50 days, while it may be shorter in children.
T/F: Most infants and young children with EBV infection develop classic symptoms of infectious mononucleosis.
False. The majority of infections in infants and young children are asymptomatic or mild.
T/F: The onset of infectious mononucleosis is usually sudden and severe.
False. The onset is usually insidious and vague, with symptoms such as malaise, fatigue, and mild fever developing over 1-2 weeks.
T/F: Splenic enlargement can occur rapidly enough to cause left upper quadrant pain.
True. Rapid splenomegaly can lead to left upper quadrant discomfort and tenderness, which may be the presenting complaint.
T/F: Generalized lymphadenopathy occurs in 90% of cases of infectious mononucleosis.
True. Lymphadenopathy is very common, occurring in 90% of cases, especially in the anterior and posterior cervical lymph nodes.
T/F: Hepatomegaly is a common feature of infectious mononucleosis, occurring in more than 50% of cases.
False. Hepatomegaly occurs in only 10% of cases, making it less common than splenomegaly or lymphadenopathy.
T/F: Epitrochlear lymphadenopathy is a particularly suggestive finding in infectious mononucleosis.
True. Swelling of the epitrochlear lymph nodes (above the elbow) is strongly associated with infectious mononucleosis.
T/F: Jaundice and severe hepatitis are common findings in infectious mononucleosis.
False. Although liver enzymes may be elevated, symptomatic hepatitis or jaundice is rare.
T/F: The sore throat in infectious mononucleosis often resembles streptococcal pharyngitis, including tonsillar enlargement and exudates.
True. Infectious mononucleosis can mimic strep throat, with marked tonsillar enlargement, exudates, and severe pharyngitis.
T/F: A maculopapular rash occurs in 3-15% of patients with infectious mononucleosis.
True. A maculopapular rash can develop in 3-15% of cases, particularly if the patient receives certain antibiotics.
T/F: Patients with EBV infection who are treated with ampicillin or amoxicillin frequently develop a characteristic rash.
True. Ampicillin or amoxicillin can trigger an immune-mediated morbilliform rash in patients with EBV infection.
T/F: The rash in infectious mononucleosis is always due to an allergic reaction to antibiotics.
False. While the ampicillin rash is immune-mediated, EBV itself can also cause Gianotti-Crosti syndrome, a distinctive symmetric rash.
T/F: Gianotti-Crosti syndrome is a rash that primarily affects the cheeks, extremities, and buttocks and may resemble atopic dermatitis.
True. Gianotti-Crosti syndrome presents as erythematous papules on the cheeks, limbs, and buttocks, often persisting for weeks.
T/F: The presence of atypical lymphocytosis in the peripheral blood can help make a presumptive diagnosis of infectious mononucleosis.
True. Atypical lymphocytes (reactive CD8 T cells) are a key feature in the diagnosis of infectious mononucleosis.
T/F: The diagnosis of infectious mononucleosis can only be confirmed through a throat culture.
False. Serologic tests, such as heterophile antibody tests (Monospot) or EBV-specific antibodies, confirm the diagnosis.
T/F: The heterophile antibody test (Monospot) is always positive in infectious mononucleosis.
False. The Monospot test may be negative early in the disease, especially in young children. EBV-specific antibody tests can be used instead.
T/F: EBV-specific antibody testing can distinguish between acute and past EBV infection.
True. EBV-specific antibodies (such as anti-VCA IgM and IgG) can differentiate acute infection from past exposure.
T/F: A throat swab for Group A Streptococcus should be done if pharyngitis is present.
True. Since strep throat and EBV pharyngitis can appear similar, a throat culture or rapid strep test may be needed to rule out streptococcal infection.
T/F: Blood tests in infectious mononucleosis typically show leukopenia with a decrease in white blood cell count.
False. Blood tests usually show leukocytosis (increased WBC count) with lymphocytosis and atypical lymphocytes.
T/F: Imaging tests like ultrasound are required for diagnosing infectious mononucleosis.
False. Imaging is not needed for diagnosis unless there are complications such as severe splenomegaly or abdominal pain.
Palatal petechiae at the junction of the hard and soft palate are frequently seen
T
EBV is the only virus that causes infectious mononucleosis.
False
Explanation: While Epstein-Barr virus (EBV) is the most common cause, other pathogens like cytomegalovirus (CMV), Toxoplasma gondii, adenovirus, and HIV can also cause infectious mononucleosis–like illnesses.
Streptococcal pharyngitis can mimic infectious mononucleosis but does not typically cause hepatosplenomegaly.
True
Explanation: Streptococcal pharyngitis presents with sore throat and cervical lymphadenopathy, similar to infectious mononucleosis, but it does not typically cause hepatosplenomegaly.
The presence of atypical lymphocytes is exclusive to EBV infection.
Explanation: Atypical lymphocytes are seen in EBV infections, but they can also appear in other infections associated with lymphocytosis. However, EBV infection classically has the highest percentage of atypical lymphocytes.
Heterophile antibody tests like the Monospot test are always positive in EBV infections.
False
Explanation: The Monospot test is positive in about 90% of cases in adolescents and adults but only in about 50% of cases in children under 4 years old.
The presence of IgM antibodies to viral capsid antigen (VCA) is the most specific serologic test for acute EBV infection.
True
Explanation: IgM antibodies to VCA appear early in infection and are highly specific for acute EBV infection, making them the most useful serologic marker for diagnosis.
Splenic rupture is a common and often fatal complication of infectious mononucleosis.
False
Explanation: Splenic rupture is rare (about 0.1% of cases) and is rarely fatal, though precautions against trauma are advised.
Alice in Wonderland syndrome, a perceptual distortion of sizes and shapes, can be a presenting symptom of EBV infection.
True
Explanation: This unusual neurological symptom, known as metamorphopsia, has been reported in cases of infectious mononucleosis.
EBV is associated with an increased risk of certain cancers, including Burkitt lymphoma and Hodgkin lymphoma.
True
Explanation: EBV is linked to several malignancies, including Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, and posttransplant lymphoproliferative disease.
Antiviral therapy is recommended for infectious mononucleosis.
False – The text states that antiviral therapy is not recommended because nucleoside analogs like acyclovir do not provide consistent clinical benefits for patients with infectious mononucleosis or EBV-associated malignancies.
Acyclovir decreases the duration of oropharyngeal viral shedding in infectious mononucleosis.
True – The text mentions that acyclovir inhibits viral replication in vitro and reduces oropharyngeal viral shedding duration in patients. However, this does not translate to significant clinical benefits.
Corticosteroids should be used in all cases of infectious mononucleosis.
useful for specific complications, such as airway obstruction, but there is not enough evidence to support their routine use for typical symptoms.
EBV-specific cytotoxic T lymphocyte therapy has shown promise for EBV-associated malignancies.
True – The text states that adoptive immunotherapy using EBV-specific cytotoxic T lymphocytes has shown some promise in early trials, particularly for transplant recipients with PTLD and other EBV-related cancers.
