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EBV Infectious Mononucleosis — RACP Adult Medicine MCQ

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EasyInfectious DiseasesEBV Infectious MononucleosisRACP Adult Medicine

A 25-year-old man presents with a 2-week history of sore throat, fever, lymphadenopathy (cervical and axillary), hepatosplenomegaly, and atypical lymphocytes (>20%) on blood film. Monospot (heterophile antibody) test is positive. ALT is 180 U/L. What is the most likely diagnosis?

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Correct answer: C — Infectious mononucleosis (EBV)

Pharyngitis, lymphadenopathy, hepatosplenomegaly, atypical lymphocytes, and positive monospot is EBV infectious mononucleosis. Hepatitis (~80%) is common but usually mild. AVOID amoxicillin/ampicillin (causes characteristic rash in ~90% with EBV). Avoid contact sports for 4 weeks (splenic rupture risk). Complications: splenic rupture, airway obstruction, autoimmune haemolytic anaemia, Guillain-Barré syndrome. Most cases resolve spontaneously in 2-4 weeks.

Reference: eTG Antibiotic – 2025 – EBV