What is involved in a comprehensive mono (monolithic) physical assessment?

Physical Assessment for Infectious Mononucleosis

A comprehensive physical assessment for suspected or confirmed infectious mononucleosis should focus on vital signs, pharyngeal examination, lymphadenopathy assessment, abdominal palpation for splenomegaly/hepatomegaly, and skin inspection for rash or jaundice. 1, 2

Initial Vital Signs and General Assessment

• Measure temperature, pulse rate, respiratory rate, blood pressure, and oxygen saturation to identify fever and assess hemodynamic stability 1, 2
• Calculate BMI using height and weight measurements 1, 2
• Evaluate overall appearance for signs of acute illness, fatigue, or distress 1, 2
• Assess level of consciousness and mental status 1, 2

Head and Neck Examination

The head and neck examination is critical in mononucleosis, as pharyngitis and lymphadenopathy are hallmark features:

• Inspect the oropharynx for tonsillar enlargement, exudates (typically white or gray patches), palatal petechiae, and uvular edema 1, 2
• Palpate cervical lymph nodes bilaterally (anterior and posterior chains) for enlargement, tenderness, mobility, and consistency—posterior cervical lymphadenopathy is particularly characteristic 1, 2
• Examine the head for symmetry and any lesions 1, 2
• Palpate the thyroid gland to rule out concurrent thyroid pathology 1

Abdominal Assessment

Abdominal examination is essential to detect splenomegaly and hepatomegaly, which occur in approximately 50% and 10-15% of mononucleosis cases respectively:

• Auscultate for bowel sounds and any vascular bruits 3
• Inspect for distension or visible masses 3
• Palpate carefully for splenomegaly (begin in the right lower quadrant and move toward the left upper quadrant to avoid missing an enlarged spleen) and hepatomegaly 1
• Assess for tenderness, particularly in the left upper quadrant where splenic rupture risk exists 3
• Palpate for any other masses or organomegaly 3

Skin Assessment

• Perform comprehensive skin examination for maculopapular rash, which may appear spontaneously or following ampicillin/amoxicillin administration (occurs in 80-100% of mono patients given these antibiotics) 1, 2
• Inspect for jaundice, which may indicate hepatic involvement 1, 2
• Assess skin for petechiae or purpura, which may suggest thrombocytopenia 1, 2
• Note skin color, moisture, temperature, and turgor 3

Cardiovascular and Respiratory Assessment

• Auscultate heart for rate, rhythm, and presence of murmurs, gallops, or rubs to rule out rare cardiac complications 3, 1
• Auscultate lungs for breath sounds, crackles, wheezes, or rubs 3
• Inspect chest wall for symmetry of movement 3

Neurological Assessment

While uncommon, neurological complications can occur in mononucleosis:

• Evaluate mental status and cognitive function for signs of encephalitis or meningitis 3, 1
• Assess coordination and gait if neurological symptoms are present 3
• Test deep tendon reflexes if indicated 3

Critical Pitfalls to Avoid

• Never palpate the spleen aggressively in confirmed or suspected mononucleosis due to risk of splenic rupture—use gentle palpation technique only 1
• Do not dismiss posterior cervical lymphadenopathy as it is more specific for mononucleosis than anterior chain involvement 1, 2
• Recognize that the classic triad (fever, pharyngitis, lymphadenopathy) may not be complete at initial presentation 4, 5
• Document spleen size carefully if palpable, as this guides activity restrictions and follow-up 1

Documentation Requirements

• Record all findings systematically, including specific measurements of lymph node size and organ enlargement 1, 2
• Note the presence or absence of key findings (tonsillar exudates, splenomegaly, rash) as these guide diagnosis and management 1, 2
• Document any contraindications to physical activity based on splenomegaly findings 3, 1