Infectious Mononucleosis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍fatiguesore throatfever

Symptoms include:

‍fatigue

‍hypersomnia

‍sore throat

‍swollen tonsils

‍fever, up to ‍°, over ‍ ‍hoursdays

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍body aches

‍swollen lymph nodes

‍rash

‍loss of appetite

‍night sweats

‍jaundice

‍nausea

‍dyspnea, ‍at reston exertion

‍petechiae

‍dizziness



Worsening factors: ‍nonephysical exertioncognitive activitystress

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍exposure to individual with strep throat

‍exposure to individuals with mononucleosis

‍aged 15 to 30

no history of: ‍anemia, ‍hypothyroidism, ‍immunodeficiency disorders, ‍autoimmune disorders





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumatic, scalp ‍normalrashlesion

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Infectious mononucleosis ‍likelysuspectedpossible

DDx: infectious mononucleosis, CMV, toxoplasmosis, acute HIV infection, herpes simplex virus infection, Covid, influenza, adenovirus infection, hepatitis, streptococcal pharyngitis, acute leukemia, lymphoma, rubella, drug reaction, secondary syphilis





PLAN:

Investigations:

- Blood work: ‍CBC, ‍creatinine, ‍electrolytes, ‍LFTs, ‍CRP, ‍Monospot test, ‍EBV antibodies

- Throat culture

Treatments:

- Rest and hydration

- ‍Analgesics

- Avoidance of contact sports or heavy lifting

- Avoid alcohol

- ‍SchoolWork leave for ‍ ‍daysweeks

Further care:

- Follow-up in ‍ ‍daysweeks with repeat LFTs

- Return if symptoms worsen or if new symptoms develop

- Referral to ER if severe abdominal pain, shortness of breath, or difficulty swallowing occurs