Alex is an active senior in high school who arrives for his appointment at 3:30 p.m. to see the doctor. His girlfriend waits in the lobby while you take his vital signs, which are temperature 102, pulse 88, and blood pressure 110/80. He complains of fever, sore throat, fatigue, and swollen glands. He mentions that he just hasn’t felt well for about 10 days. He woke in the middle of last night and experienced chills and headaches, and then felt feverish. He hasn’t felt like eating all day. Results of the physical examination showed enlarged and coated tonsils, and the glands in his neck are quite swollen. Alex states that he is usually very healthy and that he is active in sports. The physician orders stat laboratory tests and tell Alex to stay home, instructing him to drink fluids and to rest in bed. He is advised to take acetaminophen for fever and is told when to expect a call with lab results. The preliminary diagnosis is possible infectious mononucleosis. He is advised that his condition is infectious, and is told to avoid transmission to another person, especially by the secretions in his mouth (saliva). The next day Alex receives a phone call from the doctor stating that the lab results confirm the diagnosis of mononucleosis and the presence of Epstein-Barr’s virus (EBV), a herpesvirus. 1. Following the history and physical taken at the initial office visit, what might you expect as the clinical diagnostic workup, and why? 2. What might you have learned about the causative agent and how it is transmitted? 3. You are assigned to reinforce the physician’s treatment plan as presented to Alex. What are the likely instructions you may discuss with Alex?
Alex is an active senior in high school who arrives for his appointment at 3:30 p.m. to see the doctor. His girlfriend waits in the lobby while you take his vital signs, which are temperature 102, pulse 88, and blood pressure 110/80. He complains of fever, sore throat, fatigue, and swollen glands. He mentions that he just hasn’t felt well for about 10 days. He woke in the middle of last night and experienced chills and headaches, and then felt feverish. He hasn’t felt like eating all day. Results of the physical examination showed enlarged and coated tonsils, and the glands in his neck are quite swollen. Alex states that he is usually very healthy and that he is active in sports. The physician orders stat laboratory tests and tell Alex to stay home, instructing him to drink fluids and to rest in bed. He is advised to take acetaminophen for fever and is told when to expect a call with lab results. The preliminary diagnosis is possible infectious mononucleosis. He is advised that his condition is infectious, and is told to avoid transmission to another person, especially by the secretions in his mouth (saliva). The next day Alex receives a phone call from the doctor stating that the lab results confirm the diagnosis of mononucleosis and the presence of Epstein-Barr’s virus (EBV), a herpesvirus.
1. Following the history and physical taken at the initial office visit, what might you expect as the clinical diagnostic workup, and why?
2. What might you have learned about the causative agent and how it is transmitted?
3. You are assigned to reinforce the physician’s treatment plan as presented to Alex. What are the likely instructions you may discuss with Alex?
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