Narcotic drugs such as oxycodone choice e are

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 treatment
if laboratory studies show
A. leukopenia with atypical leukocytosis
B. positive culture for group A beta-hemolytic Streptococcus

C. positive Mycoplasma PCR
D. positive RNA p24 antigen PCR
E. positive serum HSV PCR
Explanation:
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 Mycoplasma
pneumonia , 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 virus infection.
These agents are responsible for a number of human diseases, including
pharyngitis, but the symptoms are much milder. Herpes virus infection 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.