Sunday, March 24, 2013


Q1: Young patient with fever(100.4 F) and fatigue more than 1 week, BP 110/72, HR 75/min, with hepatomegaly, and lymphanopathy with "owls eyes" in the cytology sample.
A1: Mononucleosis by CMV (non infectious).

Focus in the MindMap
  • MONO is a monkey in Spanish = MONOnucleosis.
  • Ebstein Barr and CMV produce mononucleosis, the first infectious and the second is non infectious or "MONONUCLEOSIS LIKE SYNDROME". Acute toxoplasmosis and HIV produce this syndrome too.
  • Einstein is real or YES = infectoiuos, YES monospot or positive.
  • The mirror is unreal or NO = NON infectious, NO monospot or negative.
  • Monospot test = Heterophile antibody test.
  • Einstein has a big belly (hepato-splenomegaly), CMV does not have organomegalies.
  • Einstein is a good person with children (rare cause of congenital defects), CMV produces many congenital defects.
  • To remember the EBV structure:
    • Lineal: is a tall Einstein with smart DNA
    • Double-stranded: two viruses EBV vs CMV
    • Enveloped: Einstein wears a coat is not naked.
High Yields
Q2: Patient with blister-like lesions in the penis, and tenderness radiated to the inguinal area. Patient states similar episodes during the past 3 years, and positive Tzanck smear. Where is the latency place of the causal agent?
A2: Sacral ganglia.
  • B cells are the latency site for EBV.
  • Macrophages are the latency site for CMV.
  • HSV-1 are the latency site in the trigeminal ganglia.
  • HSV-2 are the latency site in the sacral ganglia.
  • HVZ are the latency site in the dorsal ganglia.
  • EBV treatment with penicillin derivatives (ampicilline) lead maculopapular rash.
Q3: Examination of tissue obtained on biopsy shows a tree-like proliferation of epithelium associated to fibrous stroma. What is most likely to be seen on a PAP smear?
A3: Koilocites.
  • Koilocites = HPV
  • Cowdry type A inclusions = HVS
  • Guarnieri bodies = Poxvirus (moluscus contagiosum)
  • Negri bodies = Rabies
  • Owl eyes = CMV
Q4: Patient with a HIV/AIDS history complaining of blurry vision in the left eye and occasional flashes of bright lights. Fundouscopic exam shows retinal lesions with small areas of hemorrhage. CD4+ count of 30/mm3. What medication will be prescribed and what is the mechanism of action?
A4: CMV retinitis treatment = Ganciclovir -> activated by viral protein kinases and acts an analog to dGTP.

Q5: A 22-year-old man visits his college medical center complaining of flu-like symptoms that have persisted for about a week. He reports low-grade fevers, night sweats, a painful sore throat, headaches, and increasing fatigue. He used to exercise 5 days a week but is no longer able to because of a "lack of energy." Physical examination reveals enlarged cervical lymph nodes and a spleen that is palpable 2 inches below the left costal margin. What is the structure of the virus that has infected this patient?
A5: Linear, double-stranded, DNA virus with an envelop.


  1. Q: Patient 25-years-old HIV positive presents seizures, he is conscious but confused. An MRI of brain shows multiple multicentric ring-enhancing mass lesions in the brain and meninges. From which cell type did the masses most likely arise?
    A: B-cells lymphoma, associated with Epstein-Barr virus.

  2. Q: A 20-year-old college student presents complains of severe fatigue and lethargy. She experienced a recent mononucleosis infection that has resolved. Physical examination shows scleral icterus, cervical lymphadenopathy, and splenomegaly. The tips of her fingers are purple. Laboratory testing shows a decreased hemoglobin level, an appropriate reticulocyte count, and a positive heterophile test. This is Ig G or M mediated reaction?
    A:IgM-mediated (Cold) hemolytic anemia

  3. Q: A newborn boy is brought to the pediatrician for evaluation of an extensive skin rash. Physical examination shows that this child has microcephaly, hearing loss, and a petechial skin rash. The abdominal examination reveals hepatosplenomegaly. Questioning of the infant's mother reveals that she had "the flu" early in her pregnancy. A tissue sample from the infant is sent for culture, which confirms the diagnosis. Is CMV or EBV infection?
    A: CMV. Remember: Einstein is good with children.

  4. Thank you. That is very helpful