# A 22-year-old young adult presents to the clinic with complaints of severe fatigue, sore throat, and swollen lymph nodes for the past 2 weeks. Which assessment finding would be most characteristic of infectious mononucleosis? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542288 > language: ko > subject: Child Health ## 문제 A 22-year-old young adult presents to the clinic with complaints of severe fatigue, sore throat, and swollen lymph nodes for the past 2 weeks. Which assessment finding would be most characteristic of infectious mononucleosis? ## 보기 1. Presence of a sandpaper-like rash on the trunk and extremities 2. High fever with alternating chills and profuse sweating 3. Productive cough with thick, purulent sputum 4. Enlarged spleen with left upper quadrant tenderness **✔ 정답** **정답: 4** ## 해설 Splenomegaly with left upper quadrant tenderness is a hallmark of infectious mononucleosis, occurring in 50-60% of cases. Other options like sandpaper rash, high fever with chills, or productive cough are not typical findings. ## 심화 해설 Correct Answer: 4. Enlarged spleen with left upper quadrant tenderness Explanation of the Correct Answer Infectious mononucleosis (IM), most commonly caused by the Epstein-Barr virus (EBV), is characterized by the classic triad of fever, pharyngitis, and lymphadenopathy [1,3]. However, a pathophysiologically significant and clinically critical manifestation is splenomegaly (enlarged spleen), which occurs due to lymphocytic infiltration and hyperplasia within the splenic pulp. This enlargement stretches the splenic capsule, leading to a palpable spleen and left upper quadrant (LUQ) tenderness. This finding is highly characteristic of IM and is a key assessment focus because of the risk of a life-threatening complication: atraumatic splenic rupture [2]. The spleen is most vulnerable during the second and third weeks of illness, which aligns with the patient's 2-week history. The tenderness is a direct clinical correlate of capsular distension and potential subcapsular infarction or hemorrhage [4]. Therefore, LUQ pain and tenderness in a patient with a mononucleosis-like syndrome should immediately raise concern for splenic involvement, making this the most characteristic and high-stakes assessment finding among the options. Analysis of Other Options Option 1: Presence of a sandpaper-like rash on the trunk and extremities. A sandpaper-like rash is a classic dermatological finding for scarlet fever, which is caused by group A Streptococcus pyogenes producing an erythrogenic toxin. While a maculopapular rash can occur in IM, particularly after the administration of ampicillin or amoxicillin, it is not a primary diagnostic feature and is not described as sandpaper-like. This option points toward a streptococcal infection rather than a primary EBV infection. Option 2: High fever with alternating chills and profuse sweating. This pattern of fever, known as a hectic or Pel-Ebstein fever pattern, is more classically associated with lymphomas, such as Hodgkin's lymphoma, or with deep-seated bacterial infections like an abscess. Although high-grade episodic fever can occur in IM [1], the specific cyclical pattern of alternating chills and drenching sweats is not a typical or most characteristic presentation of uncomplicated IM. It is a red flag for other serious underlying conditions that might be part of a differential diagnosis. Option 3: Productive cough with thick, purulent sputum. A productive cough with purulent sputum is a hallmark sign of a lower respiratory tract bacterial infection, such as pneumonia or acute bronchitis. IM is a viral illness that primarily affects the lymphoreticular system. While pharyngitis is a core symptom, it is typically exudative and painful, not associated with a deep, productive cough. This option describes a pulmonary infectious process, not a systemic lymphoproliferative one. Deeper Pathophysiology and Clinical Reasoning To understand why splenomegaly is such a critical finding, you must connect the underlying pathophysiology to the clinical assessment. EBV has a tropism for B lymphocytes, infecting them and causing a massive proliferation of infected B cells. This triggers a robust cytotoxic T-cell response, leading to the accumulation of these reactive atypical lymphocytes (Downey cells) in lymphoid tissues, including the spleen [1,2]. This infiltration causes the spleen to become engorged, hyperemic, and friable. The splenic capsule is stretched, causing the LUQ tenderness on palpation. This is not just a diagnostic clue; it is a direct warning sign. The enlarged, fragile spleen is at high risk for spontaneous rupture, a surgical emergency that can present with sudden, severe LUQ pain radiating to the left shoulder (Kehr's sign), syncope, and hemorrhagic shock [2]. Even minor trauma or vigorous palpation can precipitate rupture. Furthermore, complications like splenic infarction can occur, presenting with focal LUQ pain as seen in a case where a wedge-shaped infarct was confirmed on imaging [4]. The finding of splenomegaly with tenderness directly informs critical nursing interventions: strict activity restriction, avoidance of contact sports for at least 3-4 weeks, and vigilant monitoring for signs of hemodynamic instability. A rare but severe complication like gastric volvulus, secondary to massive splenomegaly, further underscores the mechanical and life-threatening consequences of an enlarged spleen [3].References (research sources) - [1]Infectious Mononucleosis: An Uncommon Presentation of a Common Disease-a Case Report.Case reportMoini M, Sheibani S, Ghazizadeh M. (2026) · DOI: 10.1002/ccr3.72222 - [2]Atraumatic Splenic Rupture as the Sole Manifestation of Infectious Mononucleosis: A Case Report and Literature Review.Case reportCoppola A, Apostolou M, Delle Donne HD, Ferrante P, Bagnoli PF. (2026) · DOI: 10.7759/cureus.105885 - [3]A Rare Complication of Gastric Volvulus in Infectious Mononucleosis: A Case Report.Case reportWu X, Deng L, Chen Y, Zhou X, Yang J, Song Y. (2026) · DOI: 10.7759/cureus.103230 - [4]Splenic Infarction as a Complication of Acute Epstein-Barr Virus Infection in an 18-Year-Old Woman.Research articleAngbuhang P, Amer A, Vaulks A, Pathan S, Abu Laban AMB. (2026) · DOI: 10.7759/cureus.107816 ## 임상 시나리오 Assessing for Splenomegaly in MononucleosisA critical safety assessment to prevent life-threatening rupture In a patient with suspected infectious mononucleosis, the most characteristic high-risk finding is splenomegaly with left upper quadrant (LUQ) tenderness. This occurs due to lymphocytic infiltration stretching the splenic capsule. The spleen is most vulnerable to atraumatic rupture during the second and third weeks of illness. Palpation of the spleen must be performed gently to avoid iatrogenic injury. CautionDo not palpate deeply or vigorously if splenomegaly is suspected. Any complaint of LUQ pain or sudden, sharp abdominal pain with signs of shock requires immediate evaluation for splenic rupture. ## 핵심 개념 - **Splenomegaly** — Enlargement of the spleen, in mononucleosis caused by lymphocytic infiltration, leading to a palpable mass and risk of rupture. - **Infectious Mononucleosis** — A viral illness, most often caused by Epstein-Barr virus, characterized by the triad of fever, pharyngitis, and lymphadenopathy. - **Left Upper Quadrant (LUQ) Tenderness** — Pain upon palpation of the left upper abdominal quadrant, a key clinical sign of splenic capsular stretching or inflammation. - **Epstein-Barr Virus (EBV)** — A herpesvirus that is the primary etiological agent of infectious mononucleosis, transmitted through bodily fluids. - **Atraumatic Splenic Rupture** — A life-threatening complication of splenomegaly where the spleen ruptures without significant trauma, a primary concern in acute mononucleosis. ## 같은 주제 문제 - [A 16-year-old adolescent presents to the clinic with complaints of severe fatigue, sore th…](https://mymerci.kr/pages/nclex_q.php?qn_id=542286) - [A nurse is assessing a 16-year-old adolescent who presents with fever, sore throat, and fa…](https://mymerci.kr/pages/nclex_q.php?qn_id=542287) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._