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Old 07-06-2011
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Kids A 5 year old boy with fever,soar throat and swollen lymph nodes

A 5 year old boy with fever, soar throat and swollen lymph nodes. The tip of the spleen is palpable. Throat culture and rapid slide (monospot) test results are negative. The next best step will be which of the following?

A. Rapid streptococcal antigen test
B. Heterophil titer
C. Epstein-Barr virus titer
D. Chest x-ray
E. Bone marrow examination
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Old 07-06-2011
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B. Heterophil AB titer the answer is initial test if negtive we do EBV ab test
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Old 07-06-2011
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Patients with suspected IM based upon the history and physical examination should have a white blood cell count with differential and a heterophile test.
If the heterophile test is positive, no further testing is necessary if the clinical scenario is compatible with typical IM. If the heterophile test is negative, but there is still a strong clinical suspicion of EBV infection, the Monospot test can be repeated since testing can be negative early in clinical illness. If the clinical syndrome is prolonged, or if the patient does not have a classic EBV syndrome, IgM and IgG VCA and EBNA antibodies should be measured. The presence of IgG EBNA within four weeks of symptom onset excludes acute primary EBV infection as an explanation and therefore should prompt consideration of EBV-negative causes of mononucleosis. (Uptodate)

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Old 07-06-2011
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[QUOTE=amirh899;51773][COLOR=#000000][FONT=Times New Roman][LEFT][FONT=Verdana]Patients with suspected IM based upon the history and physical examination should have a white blood cell count with differential and a heterophile test.
If the heterophile test is positive, no further testing is necessary if the clinical scenario is compatible with typical IM. If the heterophile test is negative, but there is still a strong clinical suspicion of EBV infection, the Monospot test can be repeated since testing can be negative early in clinical illness. If the clinical syndrome is prolonged, or if the patient does not have a classic EBV syndrome, IgM and IgG VCA and EBNA antibodies should be measured. The presence of IgG EBNA within four weeks of symptom onset excludes acute primary EBV infection as an explanation and therefore should prompt consideration of EBV-negative causes of mononucleosis. (Uptodate)

Answer is B. Could not have said it better
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