Epstein-Barr virus US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Epstein-Barr virus. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Epstein-Barr virus US Medical PG Question 1: A 20-year-old man presents to the emergency department with complaints of severe malaise, fevers, and sore throat for the past 7 days. He also has had episodes of nausea and vomiting during this period. He does not smoke or drink alcohol. There is no family history of liver disease. His blood pressure is 130/80 mm Hg, temperature is 38.3℃ (100.9℉), pulse is 102/min, and respiratory rate is 20/min. On physical examination, he appears ill with bilateral cervical lymphadenopathy. His tonsils are erythematous and enlarged. There is no jaundice and he is mildly dehydrated. Abdominal examination demonstrates splenomegaly. The laboratory findings are shown below:
Hemoglobin 15 g/dL
Platelet count 95,000/mm³
Leukocytes 13,500/mm³
Neutrophils 50%
Atypical lymphocytes 34%
AST 232 U/L
ALT 312 U/L
ALP 120 U/L
GGT 35 U/L
Total bilirubin 1.2 mg/dL
Direct bilirubin 0.2 mg/dL
PT 12 seconds
The serologic test for hepatitis A, B, and C, CMV, and leptospirosis are negative. Serology for both serum IgM and IgG antibodies for EBV capsid antigen are positive, but the heterophile antibody test is negative. What is the most likely reason for the negative heterophile test?
- A. Concurrent viral hepatitis A infection
- B. CMV infection
- C. Low specificity
- D. Age of the patient
- E. False negative (Correct Answer)
Epstein-Barr virus Explanation: ***False negative***
- The **heterophile antibody test (Monospot test)** has a sensitivity of only **70-92%** for infectious mononucleosis, meaning false negatives occur in **10-25% of cases**.
- Heterophile antibodies typically appear **1-2 weeks after symptom onset**, and this patient has been symptomatic for only **7 days**, making it likely the heterophile antibodies have not yet developed to detectable levels.
- The positive **EBV IgM and IgG for capsid antigen** confirm acute EBV infection, so the negative heterophile test is a **false negative** result.
- False negatives are especially common **early in the course of illness**.
*Age of the patient*
- Age 20 years is actually within the **peak sensitivity range** for heterophile antibody testing (adolescents and young adults 15-25 years have 85-90% sensitivity).
- The heterophile test is **less sensitive in young children (<12 years)**, with sensitivity as low as 30-50% in children under 4 years.
- This patient's age would not explain the negative result.
*Concurrent viral hepatitis A infection*
- Serologic testing for **hepatitis A is negative**, ruling out co-infection.
- Hepatitis A co-infection would not cause a false negative heterophile test.
*CMV infection*
- Serologic testing for **CMV is negative**, and the patient has **positive EBV-specific serology**.
- While CMV can cause heterophile-negative mononucleosis syndrome, the confirmed EBV infection makes this irrelevant.
*Low specificity*
- The heterophile antibody test has **high specificity (95-100%)** for infectious mononucleosis, meaning false positives are rare.
- The limitation of the test is its **low sensitivity**, not low specificity, which explains false negatives but doesn't directly answer why this specific test is negative.
Epstein-Barr virus US Medical PG Question 2: A 17-year-old boy comes to the physician because of body aches and sore throat for 1 week. He has no history of serious illness and takes no medications. He lives with his parents; they recently adopted a cat from an animal shelter. He is sexually active with one female partner, and they use condoms consistently. His temperature is 38.7°C (101.7°F), pulse is 99/min, and blood pressure is 110/72 mm Hg. Examination shows bilateral posterior cervical lymphadenopathy. The pharynx is red and swollen. Laboratory studies show:
Hemoglobin 15 g/dL
Leukocyte count 11,500/mm3
Segmented neutrophils 48%
Band forms 2%
Basophils 0.5%
Eosinophils 1%
Lymphocytes 45%
Monocytes 3.5%
When the patient's serum is added to a sample of horse erythrocytes, the cells aggregate together. Which of the following is the most likely causal pathogen?
- A. Cytomegalovirus
- B. Influenza virus
- C. Toxoplasma gondii
- D. Epstein-Barr virus (Correct Answer)
- E. Human immunodeficiency virus
Epstein-Barr virus Explanation: ***Epstein-Barr virus***
- The patient's symptoms (fever, sore throat, **posterior cervical lymphadenopathy**) combined with **relative lymphocytosis** and a positive test where serum aggregates **horse erythrocytes** (heterophile antibody test, Monospot) are classic for **infectious mononucleosis** caused by EBV.
- While other conditions can cause similar symptoms, the specific constellation of fever, pharyngitis, posterior cervical lymphadenopathy, and a positive heterophile antibody test is highly indicative of EBV infection, particularly in an adolescent.
*Cytomegalovirus*
- CMV can cause a **mononucleosis-like syndrome** with fever, malaise, and abnormal liver function tests, but it typically presents with **absent pharyngitis** and **lymphadenopathy** is less prominent, or generalized rather than predominantly posterior cervical.
- CMV mononucleosis is characterized by a **negative heterophile antibody test**, differentiating it from EBV.
*Influenza virus*
- Influenza typically presents with an **acute onset of fever**, myalgia, headache, and respiratory symptoms like cough and rhinorrhea, and **lymphadenopathy is not a prominent feature**.
- Laboratory tests would show **neutrophilia or normal leukocyte count**, not the significant lymphocytosis seen here, and the heterophile antibody test would be negative.
*Toxoplasma gondii*
- **Toxoplasmosis** can cause **lymphadenopathy**, particularly cervical, but it's often **painless** and generalized. Pharyngitis and significant systemic symptoms like a high fever are less common, and it typically does not present with the same dramatic lymphocytosis.
- The positive heterophile antibody test in this case points away from toxoplasmosis, which would require specific serology for diagnosis and is sometimes linked to **cat exposure**, though not the primary finding here.
*Human immunodeficiency virus*
- **Acute HIV seroconversion syndrome** can present with a **mononucleosis-like illness**, including fever, pharyngitis, rash, and generalized lymphadenopathy, but **posterior cervical lymphadenopathy** specifically is not as classic as with EBV.
- The heterophile antibody test would be **negative** in HIV; diagnosis relies on HIV antigen/antibody testing or viral load measurement.
Epstein-Barr virus US Medical PG Question 3: A 28-year-old male with a history of HIV infection is found to have a CD4+ T lymphocyte count of 68 cells per microliter. As a consequence of his HIV infection, this patient is at increased risk of malignancy due to which of the following?
- A. Pneumocystis jiroveci
- B. Actinomyces israelii
- C. Helicobacter pylori
- D. HHV-6
- E. Epstein-Barr Virus (EBV) (Correct Answer)
Epstein-Barr virus Explanation: ***Epstein-Barr Virus (EBV)***
- **EBV** is a major cause of **AIDS-related malignancies**, particularly **B-cell lymphomas** including **non-Hodgkin lymphoma (NHL)** and **primary CNS lymphoma**, which are common in patients with CD4 counts below 100 cells/µL.
- The severe immunosuppression in **HIV/AIDS** allows for unchecked **EBV-driven lymphoproliferative disorders** due to impaired T-cell surveillance of EBV-infected B cells.
- Among the options listed, **EBV** is the only **oncogenic virus** and represents a significant cause of morbidity in advanced AIDS patients.
- **Note:** While HHV-8 (KSHV) causing Kaposi's sarcoma is also a major AIDS-related malignancy, it is not among the listed options.
*Pneumocystis jiroveci*
- **Pneumocystis jiroveci pneumonia (PCP)** is a common opportunistic **fungal infection** in HIV patients with CD4 < 200 cells/µL, causing severe respiratory illness.
- **PCP** is not oncogenic and does not increase malignancy risk; it causes acute infection, not cellular transformation.
*Actinomyces israelii*
- **Actinomyces israelii** is a gram-positive **bacterium** causing **actinomycosis**, a chronic suppurative infection with abscess formation and sinus tracts.
- While it can cause opportunistic infections in immunocompromised patients, it is **not oncogenic** and not associated with malignancy risk.
*Helicobacter pylori*
- **H. pylori** is a bacterium associated with **gastric adenocarcinoma** and **gastric MALT lymphoma** in the general population through chronic gastric inflammation.
- However, in the context of advanced HIV/AIDS with CD4 < 100, the predominant malignancy risk is from **oncogenic viruses** (EBV, HHV-8), not gastric pathology from **H. pylori**.
- **H. pylori** is not typically considered an AIDS-defining or AIDS-related malignancy.
*HHV-6*
- **Human Herpesvirus 6 (HHV-6)** causes roseola infantum in children and can reactivate in immunocompromised patients, potentially causing encephalitis or pneumonitis.
- **HHV-6** is **not established as oncogenic** and lacks strong evidence linking it to malignancy in HIV patients, unlike **EBV** (lymphomas) or **HHV-8** (Kaposi's sarcoma).
Epstein-Barr virus US Medical PG Question 4: An 82-year-old woman is brought to the physician by her daughter because of a 3-day history of a runny nose, headache, and cough. The patient's grandson recently had similar symptoms. Her vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 99%. Lungs are clear to auscultation. Testing of nasal secretions is performed to identify the viral strain. Electron microscopy shows a non-enveloped RNA virus with an icosahedral capsid. Binding to which of the following is responsible for the virulence of this virus?
- A. CD21
- B. Integrin
- C. ICAM-1 (Correct Answer)
- D. P antigen
- E. Sialic acid residues
Epstein-Barr virus Explanation: Both the clinical presentation (runny nose, headache, cough, viral spread) and the electron microscopy finding of a **non-enveloped RNA virus with an icosahedral capsid** are characteristic of a **rhinovirus** (a member of the Picornaviridae family).
***Correct: ICAM-1***
- **Rhinoviruses** primarily infect the upper respiratory tract and bind to **ICAM-1 (intercellular adhesion molecule-1)** on respiratory epithelial cells.
- Approximately **90% of rhinovirus serotypes** use ICAM-1 as their primary cellular receptor.
- This binding facilitates viral entry and is the key factor in the **virulence** of rhinovirus, leading to common cold symptoms.
*Incorrect: CD21*
- **CD21** is the receptor for **Epstein-Barr virus (EBV)**, which causes infectious mononucleosis, a condition distinct from the common cold.
- EBV is an **enveloped DNA virus**, unlike the non-enveloped RNA virus described in this case.
*Incorrect: Integrin*
- **Integrins** are cell adhesion receptors used by some viruses for entry (e.g., certain adenoviruses and enteroviruses).
- However, they are **not the primary receptor** for rhinovirus, which predominantly uses ICAM-1.
- The description of an **icosahedral non-enveloped RNA virus** with upper respiratory symptoms specifically points to rhinovirus and ICAM-1.
*Incorrect: P antigen*
- The **P antigen** (globoside) is the receptor for **parvovirus B19**, which causes Fifth disease (erythema infectiosum) and aplastic crisis.
- Parvovirus B19 is a **non-enveloped DNA virus** (not RNA), which is distinct from the virus described in this question.
*Incorrect: Sialic acid residues*
- **Sialic acid residues** are the receptors for **influenza viruses** (via hemagglutinin) for viral attachment and entry.
- Influenza viruses are **enveloped RNA viruses** and typically cause more severe systemic symptoms (fever, myalgias) than the mild upper respiratory symptoms described here.
Epstein-Barr virus US Medical PG Question 5: A 6-year-old boy is brought to a primary care provider by his adoptive parents for evaluation of a 3-month history of jaw swelling. He has a travel history of recent immigration from equatorial Africa where his deceased mother was positive for HIV and died from related complications. On physical exam, extensive lymph node swelling on the left side of his jaw is noted. There is also an ulceration that appears to be infected. Fine needle biopsy of the lymph node yields a diagnosis of Burkitt’s lymphoma by the pathologist. Which of the following is most likely associated with the involvement of lymph nodes around his jaw?
- A. Ethnicity of the patient
- B. Close family member with HIV
- C. Gender of the patient
- D. Recent immigration from equatorial Africa (Correct Answer)
- E. Infected ulcer
Epstein-Barr virus Explanation: ***Recent immigration from equatorial Africa***
- **Endemic Burkitt's lymphoma**, common in equatorial Africa, typically manifests as a **jaw mass** in children and is strongly associated with **Epstein-Barr virus (EBV)**.
- The patient's history of immigration from this region directly links to the presentation of Burkitt's lymphoma in his jaw.
*Ethnicity of the patient*
- While certain ethnic groups may have higher predispositions to specific diseases, ethnicity itself is not the primary determinant for the **endemic presentation of Burkitt's lymphoma** in the jaw.
- The **geographical region** (equatorial Africa) is a more direct and stronger risk factor for this specific clinical picture.
*Close family member with HIV*
- HIV infection can increase the risk of **immunodeficiency-associated lymphomas**, but it doesn't specifically explain the characteristic **jaw involvement** seen in endemic Burkitt's lymphoma.
- The mother's HIV status indicates a potential compromised immune system in the patient, which can be a predisposing factor for lymphomas in general, but not specifically for the jaw location of Burkitt's lymphoma.
*Gender of the patient*
- **Burkitt's lymphoma** does not show a significant predilection for one gender over the other to explain the specific jaw involvement.
- The presentation is more tied to **geographic and immunological factors** than to the patient's gender.
*Infected ulcer*
- The infected ulcer is a **secondary complication** or a symptom that may arise from the rapidly growing tumor, indicating opportunistic infection, rather than the primary cause or association for the specific location of the lymphoma.
- It doesn't explain why the lymphoma initially presented in the **jaw lymph nodes**.
Epstein-Barr virus US Medical PG Question 6: A 22-year-old man presents to the emergency department with a fever and a sore throat. He has had these symptoms for the past 2 weeks and has felt progressively more fatigued. His temperature is 102°F (38.9°C), blood pressure is 120/68 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for tonsillar exudates, posterior cervical lymphadenopathy, and splenomegaly. Which of the following is the most appropriate next step in management for this patient?
- A. No further workup needed
- B. Rapid strep test
- C. Amoxicillin
- D. Oseltamivir
- E. Monospot test (Correct Answer)
Epstein-Barr virus Explanation: ***Monospot test***
- The patient's presentation with **fever**, **sore throat**, **tonsillar exudates**, **posterior cervical lymphadenopathy**, and **splenomegaly** for 2 weeks is highly suggestive of **infectious mononucleosis**.
- A **Monospot test** (heterophile antibody test) is the most appropriate initial diagnostic step to confirm the diagnosis of infectious mononucleosis.
*No further workup needed*
- This is incorrect because the patient has a constellation of symptoms and physical findings suggestive of a specific condition that warrants **diagnostic confirmation** for appropriate management and to rule out other possible causes.
- Without further workup, the underlying condition remains undiagnosed, potentially leading to **mismanagement** or delayed treatment of complications.
*Rapid strep test*
- While a **sore throat** with exudates can suggest streptococcal pharyngitis, the presence of **splenomegaly** and **posterior cervical lymphadenopathy** in this age group makes infectious mononucleosis a more likely diagnosis.
- A rapid strep test might be negative and would not explain the splenomegaly or prolonged symptoms, potentially delaying the correct diagnosis.
*Amoxicillin*
- Administering **amoxicillin** to a patient with infectious mononucleosis can cause a **characteristic maculopapular rash**, which is often mistaken for an allergic reaction.
- Additionally, infectious mononucleosis is caused by a **virus (EBV)**, so antibiotics like amoxicillin are ineffective and not indicated for treatment unless a co-occurring bacterial infection is confirmed.
*Oseltamivir*
- **Oseltamivir** is an antiviral medication specifically used for the treatment of **influenza**.
- This patient's symptoms are not typical for influenza, and the duration of illness (2 weeks) along with specific physical findings like splenomegaly point away from influenza and towards infectious mononucleosis.
Epstein-Barr virus US Medical PG Question 7: A 16-year-old male is brought to the clinic by his mother for the complaints of fever, nonproductive cough, fatigue, lack of appetite, and sore throat for the past 2 months. Several other students at his high school have had similar symptoms. Physical exam shows a whitish membrane in his oropharynx, bilateral enlarged cervical lymphadenopathy, and mild splenomegaly. Which of the following tests is most likely to diagnose his condition?
- A. Monospot test (Correct Answer)
- B. Enzyme-linked immunosorbent assay
- C. Throat culture
- D. Urine culture
- E. Chest X-ray
Epstein-Barr virus Explanation: ***Monospot test***
- The Monospot test detects **heterophile antibodies**, which are commonly produced during an acute Epstein-Barr virus (EBV) infection, the cause of **infectious mononucleosis**.
- The patient's symptoms (fever, fatigue, nonproductive cough, sore throat, cervical lymphadenopathy, splenomegaly) and the epidemiological context (several other students with similar symptoms) are highly suggestive of **infectious mononucleosis**.
*Enzyme-linked immunosorbent assay (ELISA)*
- While ELISA can detect antibodies to various pathogens, including EBV-specific antigens, the **Monospot test** is the more common and rapid initial diagnostic tool for infectious mononucleosis.
- ELISA for EBV-specific antibodies (e.g., VCA-IgM, VCA-IgG) might be used if the Monospot test is negative but clinical suspicion remains high, especially in younger children or atypical presentations.
*Throat culture*
- A throat culture is used to identify bacterial infections, such as **Streptococcus pyogenes** (strep throat).
- Although the patient has a sore throat and a whitish membrane, his other systemic symptoms (fatigue, splenomegaly, lack of appetite for 2 months) are not typical for a bacterial pharyngitis which usually responds to antibiotics. A **nonproductive cough** also makes bacterial pharyngitis less likely.
*Urine culture*
- A urine culture is used to diagnose **urinary tract infections**.
- The patient's symptoms are not indicative of a urinary tract infection.
*Chest X-ray*
- A chest X-ray is used to evaluate the lungs for conditions such as **pneumonia**, **bronchitis**, or other respiratory pathologies.
- While the patient has a nonproductive cough, the predominant systemic symptoms (fever, fatigue, lymphadenopathy, splenomegaly) point towards a systemic viral infection rather than primarily a lung issue that would be definitively diagnosed by a chest X-ray.
Epstein-Barr virus US Medical PG Question 8: An investigator is studying the effect that mutations in different parts of the respiratory tract have on susceptibility to infection. A mutation in the gene encoding for the CD21 protein is induced in a sample of cells obtained from the nasopharyngeal epithelium. This mutation is most likely to prevent infection with which of the following viruses?
- A. Epstein-Barr virus (Correct Answer)
- B. Parvovirus
- C. Cytomegalovirus
- D. Rhinovirus
- E. Human immunodeficiency virus
Epstein-Barr virus Explanation: ***Epstein-Barr virus***
- Epstein-Barr virus (EBV) primarily infects B cells by binding to the **CD21** (**CR2**) receptor, making mutations in this gene protective.
- EBV infection is associated with infectious mononucleosis and certain malignancies like **Burkitt lymphoma** and **nasopharyngeal carcinoma**.
*Parvovirus*
- **Parvovirus B19** primarily targets **erythroid progenitor cells** by binding to the **globoside receptor** (also known as P antigen).
- Mutations in **CD21** would not prevent parvovirus infection as it uses a different cellular receptor.
*Cytomegalovirus*
- **Cytomegalovirus (CMV)** has a broad tropism and infects various cell types, using multiple receptors including **heparan sulfate** and **integrins**.
- **CD21** is not a primary receptor for CMV entry, so a mutation would not significantly impact CMV infection.
*Rhinovirus*
- **Rhinoviruses**, common causes of the common cold, primarily bind to **ICAM-1** (intercellular adhesion molecule 1) on epithelial cells.
- **CD21** is not involved in rhinovirus entry, thus a mutation would not affect its infectivity.
*Human immunodeficiency virus*
- **Human immunodeficiency virus (HIV)** primarily infects CD4+ T cells, macrophages, and dendritic cells by binding to **CD4** and co-receptors **CCR5** or **CXCR4**.
- **CD21** is not used by HIV for cell entry, making the mutation ineffective against HIV infection.
Epstein-Barr virus US Medical PG Question 9: A 63-year-old man presents to his primary care physician because he has been having headaches and hearing loss. In addition, he says that he has been having difficulty opening his jaw to eat and recurrent middle ear infections. Physical exam reveals enlarged neck lymph nodes and a mass in the nasopharynx. Biopsy of the mass reveals undifferentiated squamous epithelial cells. The organism that is most likely associated with this patient's disease is also associated with which of the following disorders?
- A. Kaposi sarcoma
- B. Hepatocellular carcinoma
- C. Adult T-cell lymphoma
- D. Burkitt lymphoma (Correct Answer)
- E. Vulvar carcinoma
Epstein-Barr virus Explanation: ***Burkitt lymphoma***
- The patient's symptoms (headaches, hearing loss, difficulty opening jaw, recurrent middle ear infections, nasopharyngeal mass, enlarged neck lymph nodes) and biopsy results (undifferentiated squamous epithelial cells) point to **nasopharyngeal carcinoma**.
- **Nasopharyngeal carcinoma** is strongly associated with the **Epstein-Barr virus (EBV)**. EBV is also a causative agent in **Burkitt lymphoma**.
*Kaposi sarcoma*
- **Kaposi sarcoma** is caused by **Human Herpesvirus 8 (HHV-8)**, not EBV.
- It typically presents as vascular skin lesions and can affect visceral organs, differing from the nasopharyngeal carcinoma described.
*Hepatocellular carcinoma*
- **Hepatocellular carcinoma** is primarily associated with **Hepatitis B virus (HBV)** and **Hepatitis C virus (HCV)** infection, as well as cirrhosis from other causes.
- There is no significant association between EBV and hepatocellular carcinoma.
*Adult T-cell lymphoma*
- **Adult T-cell lymphoma** is caused by the **Human T-lymphotropic virus type 1 (HTLV-1)**.
- This is a retrovirus distinct from EBV.
*Vulvar carcinoma*
- **Vulvar carcinoma** is most frequently associated with **Human Papillomavirus (HPV)** infection, especially high-risk strains like HPV 16 and 18.
- It is not typically linked to EBV.
Epstein-Barr virus US Medical PG Question 10: A 19-year-old woman presents to the family medical center with a 2-week history of a sore throat. She says that she has felt increasingly tired during the day and has a difficult time staying awake during her classes at the university. She appears well-nourished with a low energy level. Her vital signs include the following: the heart rate is 82/min, the respiratory rate is 14/min, the temperature is 37.8°C (100.0°F), and the blood pressure is 112/82 mm Hg. Inspection of the pharynx is depicted in the picture. Palpation of the neck reveals posterior cervical lymphadenopathy. The membrane does not bleed upon scraping. What is the most specific finding for detecting the syndrome described in the vignette?
- A. > 10% atypical lymphocytes
- B. Positive rapid strep test
- C. Growth in Loffler’s medium
- D. Increased transaminase levels
- E. Positive monospot test (Correct Answer)
Epstein-Barr virus Explanation: ***Positive monospot test***
- The patient's symptoms (sore throat, fatigue, posterior cervical lymphadenopathy, pharyngitis with exudates, age) are highly suggestive of **infectious mononucleosis**, which is caused by the **Epstein-Barr virus (EBV)**.
- A **positive monospot test**, which detects **heterophile antibodies**, is the most specific and widely used rapid diagnostic test for infectious mononucleosis.
* > 10% atypical lymphocytes*
- While **atypical lymphocytes** are characteristic of infectious mononucleosis, they are not exclusive to EBV infection and can be seen in other viral infections (e.g., CMV, HIV). Therefore, this finding is less specific than a positive monospot test.
- A definitive diagnosis usually requires a combination of clinical symptoms and specific serological tests like the **monospot test** or **EBV-specific antibodies**.
*Positive rapid strep test*
- A rapid strep test detects **Group A Streptococcus (GAS)**. While bacterial pharyngitis can present with a sore throat, the accompanying fatigue and posterior cervical lymphadenopathy make streptococcal pharyngitis less likely as the primary diagnosis.
- The rapid strep test would be negative in infectious mononucleosis, and therefore, a positive result would rule out mononucleosis as the sole cause.
*Growth in Loffler’s medium*
- **Loffler's medium** is used to culture **Corynebacterium diphtheriae**, the causative agent of diphtheria. Diphtheria presents with a severe sore throat and a tenacious gray membrane that **bleeds upon scraping**, unlike the description in the vignette.
- While it's a specific diagnostic test for diphtheria, the patient's presentation does not align with diphtheria, and this test would not be positive in infectious mononucleosis.
*Increased transaminase levels*
- **Increased transaminase levels** (AST, ALT) indicate liver involvement, which can occur in infectious mononucleosis due to **hepatitis**.
- While this is a common finding in many cases of mononucleosis (and supports the diagnosis), it is an indicator of organ involvement rather than a specific diagnostic test for the presence of the virus or its unique immunological response (like the monospot test).
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