EBV

Question 1

1. T/F: Epstein-Barr virus (EBV) is a single-stranded RNA virus.

Answer 1

False. EBV is a double-stranded DNA virus belonging to the gammaherpesvirus family.

Question 2

T/F: EBV infection always results in symptomatic infectious mononucleosis.

Answer 2

False. Many EBV infections are asymptomatic, especially in children.

Question 3

T/F: Infectious mononucleosis can be caused by pathogens other than EBV.

Answer 3

True. Cytomegalovirus, Toxoplasma gondii, adenovirus, hepatitis viruses, and HIV can also cause infectious mononucleosis–like illness.

Question 4

T/F: EBV is primarily transmitted through respiratory droplets in the air.

Answer 4

False. EBV is mainly transmitted through oral secretions (saliva), not airborne transmission.

Question 5

T/F: EBV can be shed intermittently for life in infected individuals.

Answer 5

True. After the acute infection, EBV can be intermittently shed in oral secretions for life.

Question 6

T/F: Nonintimate contact and fomites are major contributors to EBV transmission.

Answer 6

False. EBV does not spread significantly through nonintimate contact or fomites.

Question 7

T/F: In developing countries, EBV infection commonly occurs during infancy and early childhood.

Answer 7

True. In developing countries, most children are infected by 3 years of age.

Question 8

T/F: Infectious mononucleosis primarily affects children under 4 years of age.

Answer 8

False. Symptomatic infectious mononucleosis is rare in children under 4 years; it is more common in adolescents and young adults.

Question 9

T/F: After initial infection, EBV primarily infects only B lymphocytes.

Answer 9

False. EBV infects both oral epithelial cells and tonsillar B lymphocytes.

Question 10

T/F: The clinical symptoms of infectious mononucleosis are mainly due to the virus itself.

Answer 10

False. Symptoms result from the host immune response, not direct viral damage.

Question 11

T/F: The incubation period of EBV infection before symptoms appear is about six weeks.

Answer 11

True. EBV has an incubation period of approximately 6 weeks before symptom onset.

Question 12

T/F: Atypical lymphocytes in infectious mononucleosis are primarily CD8 T cells.

Answer 12

True. The atypical lymphocytes seen in blood smears are mainly activated CD8 T cells.

Question 13

T/F: Natural killer (NK) cells do not play a significant role in EBV infection.

Answer 13

False. NK cells, especially CD56 dim CD16− NK cells, are important in recognizing and attacking EBV-infected cells.

Question 14

T/F: The body can completely eliminate EBV after infection.

Answer 14

False. EBV establishes lifelong latent infection in memory B lymphocytes.

Question 15

T/F: EBV remains dormant after the primary infection and does not reactivate.

Answer 15

False. EBV can reactivate, leading to intermittent viral shedding in oral secretions.

Question 16

T/F: EBV integrates into the host cell genome as part of its latent infection.

Answer 16

False. Unlike some viruses, EBV persists as an episome in the nucleus rather than integrating into the host genome.

Question 17

T/F: During latency, only a few viral proteins are produced.

Answer 17

True. EBV nuclear antigens (EBNAs) help maintain the viral episome during the latent phase.

Question 18

T/F: Reactivation of EBV is often associated with noticeable clinical symptoms.

Answer 18

False. Reactivation usually occurs without significant symptoms in most people.

Question 19

T/F: The incubation period of infectious mononucleosis in adolescents is between 30-50 days.

Answer 19

True. The incubation period in adolescents and adults typically lasts 30-50 days, while it may be shorter in children.

Question 20

T/F: Most infants and young children with EBV infection develop classic symptoms of infectious mononucleosis.

Answer 20

False. The majority of infections in infants and young children are asymptomatic or mild.

Question 21

T/F: The onset of infectious mononucleosis is usually sudden and severe.

Answer 21

False. The onset is usually insidious and vague, with symptoms such as malaise, fatigue, and mild fever developing over 1-2 weeks.

Question 22

T/F: Splenic enlargement can occur rapidly enough to cause left upper quadrant pain.

Answer 22

True. Rapid splenomegaly can lead to left upper quadrant discomfort and tenderness, which may be the presenting complaint.

Question 23

T/F: Generalized lymphadenopathy occurs in 90% of cases of infectious mononucleosis.

Answer 23

True. Lymphadenopathy is very common, occurring in 90% of cases, especially in the anterior and posterior cervical lymph nodes.

Question 24

T/F: Hepatomegaly is a common feature of infectious mononucleosis, occurring in more than 50% of cases.

Answer 24

False. Hepatomegaly occurs in only 10% of cases, making it less common than splenomegaly or lymphadenopathy.

Question 25

T/F: Epitrochlear lymphadenopathy is a particularly suggestive finding in infectious mononucleosis.

Answer 25

True. Swelling of the epitrochlear lymph nodes (above the elbow) is strongly associated with infectious mononucleosis.

Question 26

T/F: Jaundice and severe hepatitis are common findings in infectious mononucleosis.

Answer 26

False. Although liver enzymes may be elevated, symptomatic hepatitis or jaundice is rare.

Question 27

T/F: The sore throat in infectious mononucleosis often resembles streptococcal pharyngitis, including tonsillar enlargement and exudates.

Answer 27

True. Infectious mononucleosis can mimic strep throat, with marked tonsillar enlargement, exudates, and severe pharyngitis.

Question 28

T/F: A maculopapular rash occurs in 3-15% of patients with infectious mononucleosis.

Answer 28

True. A maculopapular rash can develop in 3-15% of cases, particularly if the patient receives certain antibiotics.

Question 29

T/F: Patients with EBV infection who are treated with ampicillin or amoxicillin frequently develop a characteristic rash.

Answer 29

True. Ampicillin or amoxicillin can trigger an immune-mediated morbilliform rash in patients with EBV infection.

Question 30

T/F: The rash in infectious mononucleosis is always due to an allergic reaction to antibiotics.

Answer 30

False. While the ampicillin rash is immune-mediated, EBV itself can also cause Gianotti-Crosti syndrome, a distinctive symmetric rash.

Question 31

T/F: Gianotti-Crosti syndrome is a rash that primarily affects the cheeks, extremities, and buttocks and may resemble atopic dermatitis.

Answer 31

True. Gianotti-Crosti syndrome presents as erythematous papules on the cheeks, limbs, and buttocks, often persisting for weeks.

Question 32

T/F: The presence of atypical lymphocytosis in the peripheral blood can help make a presumptive diagnosis of infectious mononucleosis.

Answer 32

True. Atypical lymphocytes (reactive CD8 T cells) are a key feature in the diagnosis of infectious mononucleosis.

Question 33

T/F: The diagnosis of infectious mononucleosis can only be confirmed through a throat culture.

Answer 33

False. Serologic tests, such as heterophile antibody tests (Monospot) or EBV-specific antibodies, confirm the diagnosis.

Question 34

T/F: The heterophile antibody test (Monospot) is always positive in infectious mononucleosis.

Answer 34

False. The Monospot test may be negative early in the disease, especially in young children. EBV-specific antibody tests can be used instead.

Question 35

T/F: EBV-specific antibody testing can distinguish between acute and past EBV infection.

Answer 35

True. EBV-specific antibodies (such as anti-VCA IgM and IgG) can differentiate acute infection from past exposure.

Question 36

T/F: A throat swab for Group A Streptococcus should be done if pharyngitis is present.

Answer 36

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.

Question 37

T/F: Blood tests in infectious mononucleosis typically show leukopenia with a decrease in white blood cell count.

Answer 37

False. Blood tests usually show leukocytosis (increased WBC count) with lymphocytosis and atypical lymphocytes.

Question 38

T/F: Imaging tests like ultrasound are required for diagnosing infectious mononucleosis.

Answer 38

False. Imaging is not needed for diagnosis unless there are complications such as severe splenomegaly or abdominal pain.

Question 39

Palatal petechiae at the junction of the hard and soft palate are frequently seen

Answer 39

T

Question 40

EBV is the only virus that causes infectious mononucleosis.

Answer 40

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.

Question 41

Streptococcal pharyngitis can mimic infectious mononucleosis but does not typically cause hepatosplenomegaly.

Answer 41

True Explanation: Streptococcal pharyngitis presents with sore throat and cervical lymphadenopathy, similar to infectious mononucleosis, but it does not typically cause hepatosplenomegaly.

Question 42

The presence of atypical lymphocytes is exclusive to EBV infection.

Answer 42

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.

Question 43

Heterophile antibody tests like the Monospot test are always positive in EBV infections.

Answer 43

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.

Question 44

The presence of IgM antibodies to viral capsid antigen (VCA) is the most specific serologic test for acute EBV infection.

Answer 44

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.

Question 45

Splenic rupture is a common and often fatal complication of infectious mononucleosis.

Answer 45

False Explanation: Splenic rupture is rare (about 0.1% of cases) and is rarely fatal, though precautions against trauma are advised.

Question 46

Alice in Wonderland syndrome, a perceptual distortion of sizes and shapes, can be a presenting symptom of EBV infection.

Answer 46

True Explanation: This unusual neurological symptom, known as metamorphopsia, has been reported in cases of infectious mononucleosis.

Question 47

EBV is associated with an increased risk of certain cancers, including Burkitt lymphoma and Hodgkin lymphoma.

Answer 47

True Explanation: EBV is linked to several malignancies, including Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma, and posttransplant lymphoproliferative disease.

Question 48

Antiviral therapy is recommended for infectious mononucleosis.

Answer 48

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.

Question 49

Acyclovir decreases the duration of oropharyngeal viral shedding in infectious mononucleosis.

Answer 49

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.

Question 50

Corticosteroids should be used in all cases of infectious mononucleosis.

Answer 50

useful for specific complications, such as airway obstruction, but there is not enough evidence to support their routine use for typical symptoms.

Question 51

EBV-specific cytotoxic T lymphocyte therapy has shown promise for EBV-associated malignancies.

Answer 51

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.