Hy 2088 Great! Yeah, baby, yeah!….
35-year-old government agent named Austin Powers presents to the local clinic complaining of fatigue over the past week. He had previously been in excellent physical health and had been able to work 12 hours daily. He complains of diffuse myalgias and temperatures as high as 39.2 C (102.5 F). He has also been complaining of difficulty swallowing because of a sore throat. He drinks approximately 24 ounces of beer on weekends, a few (no more than 2) martinis (shaken not stirred) on weekdays and smokes one pack of cigarettes per day. On examination, his temperature is 38.7 C (101.6 F), and his posterior pharynx is injected. He has bilateral anterior and posterior cervical adenopathy, with lymph nodes measuring as large as 1 cm. They are firm, mobile, and mildly tender. On abdominal examination, his liver span is 14 cm in the midclavicular line, and a spleen tip is palpable. There is no ascites or peripheral edema. What is the dx?
2-Cirrhosis of the liver
ans) #4. This was again another tricky question with a solid concept. All the questions I heard had some kind of “curve ball” distractor. That is why you must read very carefully. The patient is presenting with the classic clinical features of infectious mononucleosis, with fever, fatigue, symptoms of pharyngitis, cervical lymphadenopathy, and hepatosplenomegaly. A heterophile agglutinin test (Monospot) should be positive at this point for EBV infection. Don’t be tricked by the drinking. I said he does not drink that much…and he would not have cervical adenopathy if he had early cirrhosis! If you were rushing and short of time, I bet you would have seen the word "beer and martinis" and then picked cirrhosis...