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3.14 Mononucleosis (Glandular Fever)


The patient is usually of school age (nursery through night school) and complains of several days of fever, malaise, lassitude, myalgias, and anorexia, culminating in a severe sore throat. The physical examination is remarkable for generalized lymphadenopathy, including the anterior and posterior cervical chains and huge tonsils, perhaps meeting in the midline and covered with a dirty-looking exudate. There may also be palatal petechiae and swelling, splenomegaly, hepatomegaly, and a diffuse maculopapular rash.

What to do:

What not to do:


All of the above probably apply to cytomegalovirus as well, although the severe tonsillitis and positive heterophil test are both less likely. Some who report having mono twice probably actually had CMV once and mono once.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
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