Infectious mononucleosis / Glandular Fever

Question 1

Infectious mononucleosis (IM), also known as ‘mono’ or ‘glandular fever,’ is a viral infection. What is the incidence of this?

1 - 7000 cases per 100,000
2 - 700 cases per 100,000
3 - 70 cases per 100,000
4 - 7 cases per 100,000

Answer 1

3 - 70 cases per 100,000

Affects males and females equally

Question 2

Infectious mononucleosis (IM), also known as ‘mono’ or ‘glandular fever,’ is a viral infection. What age does the incidence of this peak?

1 - 50-60
2 - 30-40
3 - 20-30
4 - 5-10

Answer 2

3 - 20-30

Question 3

Which virus commonly causes Infectious mononucleosis (IM), also known as ‘mono’ or glandular fever?

1 - herpes simplex virus
2 - epstein-barr virus
3 - human immunodeficiency virus
4 - rhinovirus

Answer 3

2 - epstein-barr virus
Accounts for 90% of cases

Cytomegalovirus and Human herpesvirus 6 can also cause this

Question 4

Is a prodrome common in infectious mononucleosis?

Answer 4

• yes

Can be associated with malaise, fatigue, headache, and low-grade fever.

Question 5

Infectious mononucleosis (IM), also known as ‘mono’ or glandular fever, presents with a classical triad. Which of the following is NOT part of thus triad?

1 - Sore throat
2 - Lymphadenopathy
3 - Quinsy
4 - Pyrexia

Answer 5

3 - Quinsy

IM presents in a similar manner to bacterial tonsillitis, but in a more severe manner

Question 6

Do patients with infectious mononucleosis (IM) typically have infected tonsils?

Answer 6

• Yes

Typically have exudates on the tonsils as well

Question 7

Patients with infectious mononucleosis (IM) can have a particular appearance on the roof of their mouthes, what is this called?

1 - purpura
2 - maculation
3 - active bleeding
4 - palatal petechiae

Answer 7

4 - palatal petechiae

Question 8

The classic triad of Infectious mononucleosis (IM) is sore throat, lymphadenopathy and pyrexia. IM can affect the spleen , causing splenomegaly and even rupture. What % of patients with IM have splenomegaly?

1 - 90%
2 - 50%
3 - 10%
4 - 5%

Answer 8

2 - 50%

Lymphocytic infiltration enlarges the spleen beyond protection from the rib cage and creating an organ that is susceptible to rupture either spontaneously or traumatically.

Question 9

The classic triad of Infectious mononucleosis (IM) is sore throat, lymphadenopathy and pyrexia. IM can affect the liver, causing hepatomegaly. This can cause a transient increase in what?

1 - lactate dehydrogenase
2 - alanine transaminase
3 - creatine kinase
4 - C-reactive protein

Answer 9

2 - alanine transaminase

Question 10

Although diagnosis is typically clinical, in infectious mononucleosis, all of the following may be useful, EXCEPT which one?

1 - Blood tests:
2 - FBC, Urea & Electrolytes, CRP
3 - Glandular fever screen
4 - Neck CT
5 - Blood cultures

Answer 10

4 - Neck CT

Question 11

In infectious mononucleosis are we more likely to see lymphocytosis or lymphopenia (low lymphocyte number)?

Answer 11

• lymphocytosis

Lots of lymphocytes as they are needed to fight the infection

Bacterial infections typically cause neutropenia (low number of neutrophils) as neutrophils fight bacteria

Question 12

Patients with Infectious mononucleosis (IM), also known as ‘mono’ or ‘glandular fever,’ is a viral infection need an glandular fever screening test. One of these tests is the monospot test. The monospot test is measuring the presence of what in the blood?

1 - abnormal B cells
2 - abnormal antibodies produced by infected B cells
3 - antigens from epstein-barr virus
4 - all of the above

Answer 12

2 - abnormal antibodies produced by infected B cells

The monospot test measures presence of abnormal antibodies that binds sheet and horse RBCs, causing agglutination and a positive blood test

Can also perform EBV-specific serology (e.g., anti-VCA IgM, anti-VCA IgG, and anti-EBNA IgG) tests

Question 13

To diagnose infectious mononucleosis (IM), also known as ‘mono’ or ‘glandular fever,’ when do NICE suggest FBC and monospot test should be performed?

1 - immediately
2 - <72h
3 - 2nd week of illness
4 - 4th week of illness

Answer 13

3 - 2nd week of illness

Question 14

Patients with Infectious mononucleosis (IM), also known as ‘mono’ or ‘glandular fever,’ is a viral infection need an glandular fever screening test, including monospot test, measuring abnormal antibodies produced by infected B cells. If a patient has IM, this test may NOT be positive in which 2 of the following?

1 - young children
2 - early infection
3 - older adults >65
4 - immunocompromised

Answer 14

1 - young children
2 - early infection

Question 15

Why should penicillins be avoided if you suspect a patient has infectious mononucleosis (IM), also known as ‘mono’ or ‘glandular fever?

1 - results in anaphylaxis
2 - can cause respiratory depression
3 - leads to systemic rash, suggesting penicillin allergy
4 - need to treat with antivirals

Answer 15

3 - leads to systemic rash, suggesting penicillin allergy

Patients are then identified as having a penicillin allergy

Question 16

All of the following are typical treatments for patients with suspected infectious mononucleosis (IM), EXCEPT which one?

1 - antibiotics
2 - reassurance that symptoms will subside <1 week
3 - paracetamol / NSAIDs (oral spray)
4 - adequate fluid intake/ resuscitation
5 - dexamethasone

Answer 16

1 - antibiotics
Typically only used if bacterial confirmed or with a high suspicion of secondary bacterial infection

Dexamethasone = typically given as a one off dose

Fluid resuscitation is important as patients can present with hypovolaemic shock due to lack of fluid intake

Question 17

In patients with infectious mononucleosis, they are advised to avoid contact sports for 6-8 weeks, due to the risk of damage to which organ specifically?

1 - spleen
2 - liver
3 - heart
4 - kidneys

Answer 17

1 - spleen

Increased risk of rupture

Question 18

In patients with infectious mononucleosis, they are advised that recovery may take how long?

1 - days
2 - weeks
3 - months
4 - years

Answer 18

2 - weeks

Typically 4-6 weeks

Bacterial tonsillitis typically only takes days

Question 19

Which of the following is a complication of infectious mononucleosis?

1 - haemolytic anaemia
2 - enlarged thymus
3 - gastroesophageal reflux
4 - haemolytic anaemia

Answer 19

4 - haemolytic anaemia