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Question 7#

 A 19-year-old male patient presents with a 1-week history of malaise and anorexia followed by fever and sore throat. On physical examination, the throat is inflamed without exudate. There are a few palatal petechiae. Cervical adenopathy is present. The liver span is 12 cm and the spleen is palpable.

Which of the following is the most important initial test combination to order?

A) Liver biopsy and hepatitis antibody
B) Streptococcal screen and antistreptolysin O (ASO) titer
C) Peripheral blood smear and heterophile antibody
D) Toxoplasma IgG and stool sample
E) Lymph node biopsy and cytomegalovirus serology

Correct Answer is C


This young man presents with classic signs and symptoms of infectious mononucleosis. In a young patient with fever, pharyngitis, lymphadenopathy, and lymphocytosis, the peripheral blood smear should be evaluated for atypical lymphocytes. A heterophile antibody test should be performed. The symptoms described in association with atypical lymphocytes and a positive heterophile test are virtually always caused by Epstein-Barr virus. Neither liver biopsy nor lymph node biopsy is necessary. Workup for toxoplasmosis or cytomegalovirus infection or hepatitis B and C would be considered in heterophile-negative patients. Hepatitis does not occur in the setting of rheumatic fever, and an antistreptolysin O titer is not indicated.