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Narcotic drugs such as oxycodone (choice E)are actually very ineffective at controlling neuropathic pain. In fact, they have no recommended role in the management of this type of pain. Oxycodone, sustained release, is an oral sustained release formulation of morphine and is used for the treatment of chronic, nonneuropathic pain conditions. Sustained release formulation are not to be used for the management of acute pain.A 21-year-old woman comes to the university health clinic complaining of a 2-week history of fatigue, lethargy, and fever. She has also noticed a mild sore throat. Her past medical history is otherwise unremarkable and she takes only oral contraceptive pills for birth control and acne. Her temperature is 39.0 C (100.4 F), blood pressure is 120/75 mm Hg, pulse is 82/min, and respirations are 18/min. She appears somewhat ill, but in no clear distress. Her pharynx appears erythematous and she has mild splenomegaly. Supportive therapy and avoidance of contact sports is the appropriate treatmentif laboratory studies showA. leukopenia with atypical leukocytosisB. positive culture for group A beta-hemolytic Streptococcus
C. positive MycoplasmaPCRD. positive RNA p24 antigen PCRE. positive serum HSV PCRExplanation:The correct answer is A.This patient has infectious mononucleosis caused by the Epstein-Barr virus. This disease can present in a very similar manner to infectious pharyngitis caused by the group A beta hemolytic streptococcus. These patients typically present with more mild symptoms of fever and sore throat and in many cases have splenomegaly. The classic laboratory finding is leukopenia with atypical leukocytosis. The treatment of mono typically includes supportive therapy with avoidance of contact sports (to avoid splenic rupture).A positive culture for group A beta-hemolytic Streptococcus (choice B)would represent infection with a bacteria that causes bacterial pharyngitis, not mononucleosis. Although the presentations of the 2 diseases may be similar, their causative agents are quite dissimilar. Antibiotics are used to group A beta-hemolytic Streptococcus. A positive mycoplasma PCR (choice C)represents infection with Mycoplasmapneumonia, a common cause of atypical community acquired pneumonia in this age group. Antibiotics are used to treat this infection.A positive RNA p24 antigen PCR (choice D)would represent evidence of infection with the HIV virus. Antiviral therapy is used to treat HIV.A positive serum HSV PCR (choice E)indicates active herpes virusinfection. These agents are responsible for a number of human diseases, including pharyngitis, but the symptoms are much milder. Herpes virusinfection does not cause infectious mono. Antiviral therapy is used to treat HSV.A 55-year-old man of Indian descent returns to your clinic for the third time this month. He is frustrated with his extremely pruritic rash, which has not responded to the strong topical steroid cream prescribed for him. He also complains of a 15 pound weight loss in the past 2 months and low-grade fever.