Mononucleosis physical examination: Difference between revisions
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{{Mononucleosis}} | {{Mononucleosis}} | ||
{{CMG | {{CMG}} | ||
==Overview== | ==Overview== | ||
The classic initial presentation of mononucleosis include: [[fever]], [[ | The classic initial presentation of mononucleosis include: [[fever]], [[lymphadenopathy]], [[pharyngitis]], [[Petechial|rash]] and/or [[oedema|periorbital oedema]]. Occasionally, patients infected with [[EBV]] may also display [[splenomegaly]], with subsequent life-threatening complication of [[splenic rupture]] and/or [[hepatomegaly]]. | ||
==Physical Examination== | ==Physical Examination== | ||
====Vitals | |||
===Active EBV Infection=== | |||
====Vitals==== | |||
*[[Bradycardia]] is a rare and inconsistent finding | *[[Bradycardia]] is a rare and inconsistent finding | ||
====Skin | ====Skin==== | ||
*[[Rash|Maculopapular rash]] which is generalized, non-itchy, faint and disappears rapidly may be observed during the early phase of the disease. | *[[Rash|Maculopapular rash]] which is generalized, non-itchy, faint and disappears rapidly may be observed during the early phase of the disease. | ||
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*[[Anemia]] is uncommon, even though [[EBV|EBV infection]] induces antibodies to RBC-membranes | *[[Anemia]] is uncommon, even though [[EBV|EBV infection]] induces antibodies to RBC-membranes | ||
====Eyes | ====Eyes==== | ||
*[[oedema| | *Hoagland sign: Transient bilateral [[oedema|supra-orbital oedema]] that is observed during the early stages of infection. | ||
====Ear Nose and Throat | ====Ear, Nose and Throat==== | ||
*[[Lymphadenopathy|Tender lymphadenopathy]] is present; in particular, the posterior [[cervical lymph nodes]] on both sides of the neck are involved. | *[[Lymphadenopathy|Tender lymphadenopathy]] is present; in particular, the posterior [[cervical lymph nodes]] on both sides of the neck are involved. | ||
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*White patches may also observed in the [[tonsils]] associated with massive [[Tonsillitis|tonsilar enlargement]] which may lead to fatal [[airway obstruction]]. | *White patches may also observed in the [[tonsils]] associated with massive [[Tonsillitis|tonsilar enlargement]] which may lead to fatal [[airway obstruction]]. | ||
*[[Petechial]] [[hemorrhages]] may be observed in the posterior oropharynx; particularly involving the palate. | *[[Petechial]] [[hemorrhages]] may be observed in the posterior oropharynx; particularly involving the palate. | ||
====Abdomen | ====Abdomen==== | ||
*[[Splenomegaly|Tender splenomegaly]] is a late-feature. Following recovery from initial illness, spleen returns to normal or near normal size. | *[[Splenomegaly|Tender splenomegaly]] is a late-feature. Following recovery from initial illness, spleen returns to normal or near normal size. | ||
*[[Hepatomegaly]] | *[[Hepatomegaly]] | ||
= | ===Chronic EBV Infection=== | ||
*The course of the disease can also be chronic presenting with [[chronic fatigue syndrome]] which is a variant of mononucleosis. However, the findings need to be present for months or years to be classified as chronic EBV syndrome or [[chronic fatigue syndrome]]. | |||
*[[ | |||
*Physical findings include: | |||
*[[ | :*Significantly lower level of activity in comparison to baseline | ||
:*Impaired cognitive dysfunction, | |||
:*[[Lymphadenopathy|Tender cervical or axillary lymph nodes]] | |||
*'''''For more information, click [[Chronic fatigue syndrome physical examination|here]].''''' | |||
* | |||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Medicine]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Lymphocytes]] | |||
[[Category:Viral diseases]] | |||
Latest revision as of 18:06, 18 September 2017
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Mononucleosis Microchapters |
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Case Studies |
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Mononucleosis physical examination On the Web |
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American Roentgen Ray Society Images of Mononucleosis physical examination |
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Risk calculators and risk factors for Mononucleosis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The classic initial presentation of mononucleosis include: fever, lymphadenopathy, pharyngitis, rash and/or periorbital oedema. Occasionally, patients infected with EBV may also display splenomegaly, with subsequent life-threatening complication of splenic rupture and/or hepatomegaly.
Physical Examination
Active EBV Infection
Vitals
- Bradycardia is a rare and inconsistent finding
Skin
- Maculopapular rash which is generalized, non-itchy, faint and disappears rapidly may be observed during the early phase of the disease.
- Jaundice: varies with the age of presentation. Among young adults with mono ~5% of cases present with jaundice; however, among the elderly age group, ~30% present with anicteric viral hepatitis
- Anemia is uncommon, even though EBV infection induces antibodies to RBC-membranes
Eyes
- Hoagland sign: Transient bilateral supra-orbital oedema that is observed during the early stages of infection.
Ear, Nose and Throat
- Tender lymphadenopathy is present; in particular, the posterior cervical lymph nodes on both sides of the neck are involved.
- Pharyngitis secondary to mono may be either be exudative or non-exudative. Either type of pharyngitis is colonized by group A strep.
- White patches may also observed in the tonsils associated with massive tonsilar enlargement which may lead to fatal airway obstruction.
- Petechial hemorrhages may be observed in the posterior oropharynx; particularly involving the palate.
Abdomen
- Tender splenomegaly is a late-feature. Following recovery from initial illness, spleen returns to normal or near normal size.
- Hepatomegaly
Chronic EBV Infection
- The course of the disease can also be chronic presenting with chronic fatigue syndrome which is a variant of mononucleosis. However, the findings need to be present for months or years to be classified as chronic EBV syndrome or chronic fatigue syndrome.
- Physical findings include:
- Significantly lower level of activity in comparison to baseline
- Impaired cognitive dysfunction,
- Tender cervical or axillary lymph nodes
- For more information, click here.