A 17-year-old man presents to the clinic with new symptoms of fatigue, malaise, fever, and a sore throat. He has no significant past medical history and is not on any medications. Physical examination is entirely normal except for enlarged, palpable cervical lymph nodes. He reports no weight loss or night sweats. Laboratory investigations include a normal chest x-ray, negative throat swab, but abnormal blood film with atypical lymphocytes. The hemoglobin is 15.5 g/dL; hematocrit 42%; platelets 290,000/mL; WBC 10500/mL, with 45% segmented neutrophils, 1% eosinophils, and 54% lymphocytes, of which 36% were atypical. Which of the following is the most appropriate initial diagnostic test?
Correct Answer: heterophil antibody (Monospot) test
Description: Heterophil antibodies are present in 50% of children and 90%-95% of adolescents and adults with infectious mononucleosis. Monospot tests are the best diagnostic tools but may not turn positive until the second or third week of the illness. The presence of IgG antibodies by the indirect immunofluorescence test indicates recent or prior EBV infection. IgM antibodies indicate recent infection only. Specific EBV antibodies and cultures are rarely used.
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