Mononucleosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview[edit | edit source]

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[edit | edit source]

### Active EBV Infection[edit | edit source]

#### Vitals[edit | edit source]

* Bradycardia is a rare and inconsistent finding

#### Skin[edit | edit source]

* 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[edit | edit source]

* Hoagland sign: Transient bilateral supra-orbital oedema that is observed during the early stages of infection.

#### Ear, Nose and Throat[edit | edit source]

* 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[edit | edit source]

* Tender splenomegaly is a late-feature. Following recovery from initial illness, spleen returns to normal or near normal size.
* Hepatomegaly

### Chronic EBV Infection[edit | edit source]

* 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.

## References[edit | edit source]

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