Jason, a 13-year-old male comes in with Mom complaining of painful swallowing. Started yesterday as a “really bad sore throat” made worse with swallowing. He reports feeling very tired. His Mom gave him over-the-counter Children’s Motrin which made his fever better but did not help sore “throat. He reports his symptoms are especially, worse during nighttime. His tonsils are 2+ and erythematous, tonsil stones are present on the right side. He has white patches on his tongue.
Upon initial assessment, 13-year-old Jason presents with a complaint of painful swallowing, which began as a “really bad sore throat” and has worsened since yesterday. Jason’s mother has already administered over-the-counter medication Children’s Motrin, which has helped with his fever but not his sore throat. He reports feeling extremely tired, and his tonsils are 2+ and erythematous, with tonsil stones present on the right side. Additionally, white patches are visible on his tongue.

Clinical Impression

Jason’s symptoms, particularly the presence of tonsil stones and white patches on his tongue, suggest the possibility of an infection in his tonsils, throat, or oral cavity. Given that he is also experiencing fatigue, this could indicate that his body is fighting off an infection. However, a thorough examination and further diagnostic tests will be necessary to confirm a definitive diagnosis.

Potential Differential Diagnoses

The differential diagnoses for Jason’s symptoms include bacterial or viral pharyngitis, strep throat, tonsillitis, or oral thrush. A throat culture or a rapid strep test may be conducted to confirm the presence of strep throat. If the culture results are negative, a viral infection or tonsillitis may be the cause of the symptoms. Oral thrush, which is a type of fungal infection, may also be a possibility given the presence of white patches on Jason’s tongue.


If Jason’s diagnosis confirms bacterial tonsillitis, he may be prescribed antibiotics to help clear the infection. Over-the-counter pain relievers, like Children’s Motrin, can be used to manage pain and fever. Additionally, warm salt water gargles can help soothe a sore throat and promote healing. If the diagnosis is viral, supportive measures such as hydration and rest may be the only course of action. For oral thrush, antifungal medication may be prescribed, such as nystatin oral suspension.

Potential Complications

If left untreated, tonsillitis or strep throat can lead to complications, such as the spread of the infection to the ears, sinuses, or lungs. In some cases, tonsillitis may require surgery to remove the tonsils. Therefore, it is important to seek medical attention promptly to prevent any potential complications.

Jason’s symptoms are consistent with a bacterial or viral infection in the tonsils or throat. A thorough physical exam, along with diagnostic tests, is necessary to confirm a definitive diagnosis. Treatment may include antibiotics or antifungal medication, depending on the cause of the infection. Supportive measures, like pain relievers and warm salt water gargles, can also help alleviate symptoms. Prompt medical attention is necessary to prevent any potential complications.


Centers for Disease Control and Prevention. (2022). Group A Streptococcal (GAS) Disease. Retrieved from https://www.cdc.gov/groupastrep/diseases-public/index.html

American Academy of Otolaryngology-Head and Neck Surgery. (2022). Tonsillitis. Retrieved from https://www.enthealth.org/conditions/tonsillitis/

Mayo Clinic. (2022). Oral thrush. Retrieved from https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533

DeMuri, G. P. (2019). Acute pharyngitis in children and adolescents: Symptomatic treatment. https://www.uptodate.com/contents/acute-pharyngitis-in-children-and-adolescents-symptomatic-treatment

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