DIAGNOSIS: A CLASSIC CASE OF MONONUCLEOSIS

 

FACTS:

I contracted infectious mononucleosis as medical school commenced.

August 11, 1988-prodromal syndrome--malaise (a generally ill feeling), anorexia, chills.

August 12 to 18, 1988, I felt better so I attended classes.

August 18, and 19, 1988-acute stage of mononucleosis-pharyngitis, fever, exhaustion, malaise. August 20, 1988-Feeling poorly I consulted the on-call physician--Dr. Braunagel (University of North Dakota resident). Dr. Braunagel diagnosed the problem as mononucleosis a condition necessitating rest and restricted physical activity because of possible complications.

Throughout August and September 1988-I attended many classes. However, I fatigued easily.


Note: The following statements authored by Judy DeMers fail to mention mononucleosis. Instead, her theme attempts to deceive individuals with non-medical backgrounds into believing other factors pervade.

8-8-88 Vivian Nelson begins medical school at UNDSM (phase I - 2 weeks)

8-11-88 Vivian Nelson missed class all day (Thursday,Week 1). She did not call. When I called her, she stated she was "ill". On August 10, 1988, she had participated in a group process exercise (co-operation v. competition). The group in which she participated could not complete their task and the process had to be discontinued. This is only such occurrence in over ten years of using this specific exercise. The members of her group felt her lack of cooperation in solving the group problem was very limiting in its resolution of the problem.

8-18-88 Vivian Nelson again missed class (Thursday, Week 2) due to illness. Stated she "felt terrible, stomach upset". Both the Basic Life Support (BLS) and Biostatistics exams were administered that day. She called in this time and further notified me that she would miss class on August 19,(Friday) as well. This meant she would not be able to turn in her assignment(Patient 3, PBLM). Arrangements were made for make-up of this work. Only the PBLM patient 3 assignment was completed by Vivian. The two tests were never taken.

8-20-88 (Saturday) - I tried to call Vivian several times to see if she was okay. There was no response.

8-22-88 Phase II classes begin.


PLEASE NOTE:

 

REGULATIONS:

Appendix contains applicable regulations disregarded by the University of North Dakota.


EVIDENCE:

My complete University and medical records adequately discuss the mononucleosis and expose DeMersí above statements as an attempt to manipulate individuals with non-medical backgrounds.

 

Infectious Mononucleosis

Source: Harrisonís Principles of Internal Medicine

(This material should provide a general understanding of the variable nature of mononucleosis and the protracted convalescent period associated with this illness.)

 

EPSTEIN-BARR VIRUS INFECTIONS-INFECTIOUS MONONUCLEOSIS

CLINICAL MANIFESTATIONS -Symptoms and signs After an incubation period of 4 to 8 weeks, prodromal symptoms of malaise, anorexia, and chills frequently precede the onset of pharyngitis, fever, and lymphadenopathy by several days. Severe pharyngitis is the symptom which most frequently prompts patients to seek medical attention. Occasionally patients will note only fever or lymphadenopathy or will present with one of the complications of infectious mononucleosis. Most patients also complain of headache and malaise. Abdominal pain is infrequent in the absence of splenic rupture. Physical examination Fever is present in 90 percent of patients and may reach 39 to 40oC. Periorbital edema may be seen. The pharyngitis is usually diffuse; an exudate is observed in one-third of the cases. Hepatic tenderness is present in up to half the patients. Approximately half of all patients have splenomegaly, which is usually maximal in the second or third week of illness.

Clinical course Infectious mononucleosis is a self-limited illness in the vast majority of cases. The pharyngitis is maximal for 5 to 7 days and then resolves over the subsequent 7 to l0 days. Fever usually persists for 7 to 14 days, but occasionally may continue somewhat longer. The course of the lymphadenopathy is variable but rarely exceeds 3 weeks. The most persistent symptom is malaise. Most patients are well enough to return to work or school within 3 to 4 weeks, but occasional patients remain exhausted, have difficulty concentrating, and are unable to return to full activities for months. A group of patients has been described with nonspecific symptoms which may include malaise, fatigue, pharyngitis, fever, lymphadenopathy, and difficulty with higher cognitive function. Occasional patients have been reported in whom mortality or severe morbidity (pneumonitis, fever, pancytopenia) is associated with evidence of ongoing EBV replication.

TREATMENT -Infectious mononucleosis usually requires supportive management. Patients should be advised to obtain adequate rest. Because of the infrequent complications of splenic rupture, patients should be advised to avoid contact sports for 6 to 8 weeks after the onset of illness. The timing of return to school or work is determined solely by symptoms. Occasional patients with protracted illness may not return to a full school or work schedule for several months. Recovery from mononucleosis is often gradual and the malaise may wax and wane for some time.


Citing sovereign immunity, the University of North Dakota refuses to comply with regulations guaranteeing the opportunity to respond to this half-truth.

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