Sero-positive Conditions

Question 1

What are the two antibody tests for mono?

Answer 1

Viral capsid antibody (anti-VCA)

Epstein Barr nuclear antibody (anti-EBNA)

Question 2

What is the clinical triad for mono?

Answer 2

Pharyngitis
Pyrexia
Lymphadenopathy

Question 3

Infectious mono can cause both hepatitis and splenomegaly - T/F

Answer 3

True: 50% of patients have splenomegaly and hepatomegaly causes a mild, self resolving hepatitis. Jaundice is rare however.

Question 4

What are the common CBC findings with infections mono?

Answer 4

Leukocytosis

Lymphocytosis

Thrombocytopenia (sometimes)

Question 5

Which type of antibody is detected first, which is lifelong?

Answer 5

IgM is detected early and gone after 4 to 6 weeks

IgG appears after 2 to 4 weeks and persists

Question 6

Which antibody test for infectious mono shows IgM and/or IgG levels?

Answer 6

Anti-VCA

Question 7

The anti-EBNA test shows results after how long and for how long would those results continue to appear?

Answer 7

After acute phases (2-4 weeks); lifelong

Question 8

Which two viruses can cause infectious mono?

Answer 8

HIV and cytomegalovirus

Question 9

For how long does a patient with infectious mono need to avoid strenuous activity? Why?

Answer 9

4 to 6 weeks; splenomegaly

Question 10

Untreated group A streptococcal infections can cause what inflammatory autoimmune disease?

Answer 10

Acute Rheumatic Fever

Question 11

What age group is acute rheumatic fever most often seen in?

Answer 11

Children (5-15)

Question 12

Acute rheumatic fever causes a migratory arthritis. Which areas are most common and which is never involved?

Answer 12

Wrists, ankles and knees most common

Shoulder, hands and hips possible

Vertebrae are never involved

Question 13

How long after an initial strep infection does acute rheumatic fever develop?

Answer 13

2 to 3 weeks

Question 14

Acute rheumatic fever can cause heart valve stenosis how quickly?

Answer 14

Within 2 weeks and lasts 6 weeks to 6 months. Sometimes damage is permanent.

Question 15

Which condition can cause subcutaneous nodules and erythema marginatum?

Answer 15

Acute rheumatic fever

Question 16

What is erythema marginatum? What does it look like?

Answer 16

A flat painless rash which looks like rings and arcs

Question 17

What neurological finding can be seen late in an acute rheumatic fever infection?

Answer 17

Sydenham Chorea

Question 18

Which two tests can be used to check for acute rheumatic fever?

Answer 18

ASO titer
DNAse B

Question 19

What CBC and blood tests results expected with acute rheumatic fever?

Answer 19

Elevated acute phase reactants (CRP) and ESR

Leukocytosis
Neutrophilia

Question 20

Is the throat culture for GABHS (group A beta-hemolytic Streptococcus) a reliable test for acute rheumatic fever?

Answer 20

No, it is often negative.

Question 21

What are the diagnostic criteria for acute rheumatic fever? (Modified Jones criteria)

Answer 21

Evidence of preceding streptococcal infection and:

2+ major criteria or 1 major and 2+ minor

Major: carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules

Minor: pyrexia, arthralgia, previous ARF, lab values, prolonged P-R on ECG

Question 22

Acute rheumatic fever has a very long management plan what is it and how does carditis play a role?

Answer 22

Without carditis: 5 years of antibiotics or until you turn 21 whichever is longer

With carditis: make it 10 years or until you turn 21 whichever is longer

Question 23

Most common age range and gender for SLE?

Answer 23

Female 10:1

15-45 yo

Question 24

SLE causes arthritis which is most commonly seen where?

Answer 24

A non-erosive, non-deforming arthritis in the hands, wrists, and knees. Other locations possible.

Question 25

What is the butterfly rash common with SLE called?

Answer 25

Malar erythema

Question 26

Which organ system becomes involved with more severe SLE?

Answer 26

Renal involvement is seen in severe SLE

Question 27

CBC findings expected with SLE?

Answer 27

Hypo/micro anemia

Leukopenia

Lymphopenia

Thrombocytopenia

Elevated BUN and creatine

ESR >100 mm/hr

Question 28

Which test is a screening test and which is diagnostic when determining SLE?

Answer 28

Screening: ANA is a high sensitivity low specificity test

Diagnostic: anti dsDNA is low sensitivity and high specificity

Question 29

SLE diagnostic criteria most have 4 of the 11 following:

Answer 29

Malar rash, maculopapular rash, photosensitivity, oral/nasopharyngeal ulcers, nonerosive arthritis, pleuritis/pericarditis, proteinuria or altered kidney function tests, neurological disorder, CBC abnormalities.