Questionnaire/history?

Sore throat?

- Usually severe for 3–5 days and then gradually resolves over 7–10 days?

Fever (usually 38-39°C)?

Cervical, symmetrical lymphadenopathy?

- Posterior lymphadenopathy (most common)?

- Submandibular?

- Anterior cervical?

Past medical history?

Current medication?

Known drug allergies?

Examination:

Fever (38-39°C)?

Tonsils usually enlarged, occasionally meeting in the midline?

Pharynx may be erythematous with exudate?

Palatal petechiae?

Moderate bradycardia?

Splenomegaly (50%, max. at the beginning of the 2nd week)?

Hepatomegagly?

Jaundice?

Macular, petechial, scarlatiniform, urticarial or like erythema multiforme rash?

Investigation:

EBV (best done after 1 week of illness)?

Management:

Advised:

Paracetamol or ibuprofen

Symptoms usually last for 2–4 weeks

Tiredness is common and is often the last symptom to resolve

Exclusion from work or school is not necessary

To return to normal activities as soon as possible

If they are tired, they should tailor their activities to what they can manage comfortably

Bed rest is not normally needed

To limit the spread of the disease, by avoiding kissing and sharing eating or drinking utensils, and to thoroughly clean all items that may have been contaminated by saliva

To avoid contact or collision sports or heavy lifting for the first month of the illness (to reduce the risk of splenic rupture)

Urgent medical advice if

- Stridor or respiratory difficulty

- Difficulty swallowing fluids or have signs of dehydration, such as reduced urine output

- Systemically very unwell

- Abdominal pain (may indicate splenic rupture)

Resource(s):

CKS 2021