Mononucleosis physical examination

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Mononucleosis Microchapters


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Epidemiology and Demographics

Risk Factors


Differentiating Mononucleosis from other Diseases

Natural History, Complications and Prognosis


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


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



  • 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


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

Ear, Nose and Throat

  • Pharyngitis secondary to mono may be either be exudative or non-exudative. Either type of pharyngitis is colonized by group A strep.
  • Petechial hemorrhages may be observed in the posterior oropharynx; particularly involving the palate.


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:
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