A 16-year-old patient presents with sore throat, cervical ...

[daltonest1984]

A 16-year-old patient presents with sore throat, cervical lymphadenopathy, fever, extreme fatigue, and left upper quadrant pain. The physical examination reveals splenomegaly. The clinician should recognize the probability of:
 
  A. Bacterial endocarditis
  B. Infectious mononucleosis
  C. Pneumonia with pleural effusion
  D. Pancreatic cancer

Question 2

Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this is a risk of:
 
  A. Pleural involvement
  B. Alcoholism
  C. High mortality
  D. Bile duct obstruction

[kthug]

Answer to Question 1

ANS: B
Hypersplenism is secondary to other primary disorders, most commonly cytopenic hematologic disorders, such as lymphoma, leukemia, thrombocytopenia, polycythemia, myelofibrosis, and haemolytic anemias. With the sore throat and cervical lymphadenopathy, infection due to Epstein-Barr virus is common in adolescents. Infectious mononucleosis is an important disorder to consider. Splenomegaly often occurs in infectious mononucleosis.

Answer to Question 2

ANS: C
The Ranson rule uses a score determined by MRI results, with an index possible range of 0 to 10. A categorization of patients indicates the risk of both mortality and complication from pancreatitis. Patients at the low end of the index (13) are predicted to have a low risk of mortality (3) and complications (8), whereas patients scoring at the high end (710) of the index are predicted to have a higher incidence of mortality (17) and/or complications (92).