Mononucleosis physical examination

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.

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: Physical Examination

 * 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.

Related chapters

 * Chronic fatigue syndrome physical examination