Mononucleosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
The classic initial presentation of mononucleosis include: fever, lymphadenoapthy, pharynigitis, 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
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:
- Peri-orbital oedema may be observed in 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