Presenting Complaints

• 16-year-old male patient presents with a sore throat for the past 2 days.

History of Presenting Complaint

• The patient reports a sudden onset of a sore, scratchy throat that has been progressively worsening over the past 2 days.
• He also complains of difficulty swallowing solid foods and a mild fever of 100.5°F (38°C).
• He denies any cough, runny nose, or other respiratory symptoms.
• He states that his parents and younger sister have also been experiencing sore throats over the past week.
• The patient recently returned from a family trip to Beijing 3 days ago.

Significant Positives & Negatives For Differentials

Viral Pharyngitis

Positives:

• Sudden onset of sore throat
• Mild fever
• Lack of significant respiratory symptoms (e.g., cough, nasal congestion)
• Recent travel history and family members with similar symptoms

Negatives:

• Presence of exudative tonsils or pharyngeal erythema
• Presence of lymphadenopathy
• Lack of response to symptomatic treatment

Streptococcal Pharyngitis

Positives:

• Sudden onset of sore throat
• Presence of exudative tonsils or pharyngeal erythema
• Presence of fever
• Presence of cervical lymphadenopathy

Negatives:

• Lack of significant respiratory symptoms (e.g., cough, nasal congestion)
• Negative rapid strep test or throat culture

Infectious Mononucleosis

Positives:

• Sore throat
• Fever
• Lymphadenopathy
• Fatigue
• Splenomegaly

Negatives:

• Lack of significant respiratory symptoms (e.g., cough, nasal congestion)
• Absence of posterior cervical, axillary, or inguinal lymphadenopathy
• Negative monospot test or Epstein-Barr virus (EBV) serology

Past Medical History

• No significant past medical history.
• Up-to-date on all childhood vaccinations.

Drug/Medication History

• No regular medications.
• Denies any recent antibiotic use.

Social History

• Lives at home with parents and younger sister.
• Attends high school and participates in sports.
• Denies any tobacco, alcohol, or recreational drug use.

Family History

• Mother has a history of seasonal allergies.
• Father and sister are generally healthy.

Systems Review

• General: Mild fever, no chills or sweats.
• HEENT: Sore, scratchy throat, difficulty swallowing, no nasal congestion or rhinorrhea.
• Respiratory: No cough, wheezing, or shortness of breath.
• Cardiovascular: Regular heart rate and rhythm, no chest pain.
• Gastrointestinal: Decreased appetite, no nausea, vomiting, or diarrhea.
• Musculoskeletal: No joint pain or muscle aches.
• Skin: No rashes or lesions.

Ideas, Concerns & Expectations

• The patient is concerned that he may have strep throat and is hoping for treatment to relieve his symptoms.

Case Presentation Based on the patient's presentation and the significant positives and negatives for the differential diagnoses, the most likely diagnosis is viral pharyngitis. The sudden onset of sore throat, mild fever, and lack of significant respiratory symptoms are consistent with a viral etiology. While streptococcal pharyngitis and infectious mononucleosis are also possibilities, the absence of exudative tonsils/pharyngeal erythema, lymphadenopathy, and negative rapid strep test or monospot test make these less likely. Further evaluation with a rapid strep test or throat culture would be necessary to rule out streptococcal pharyngitis.