I need a response for 2 peers, below is the case study:

Male    20 y/o    Self employee landscaping   Marihuana ocassional user. Heterosexual choices with no regular single  partner. He loves parties and Practice Soccer regularly.

Ricardo does not speak English so he comes to see you with his sister. She says that he has a very sore throat and feels very tired. On closer questioning, you find out that the sore throat started approximately 24 hours ago. He has pain on swallowing, and he does not have a cough. He has not taken any tablets for pain. On examination, Ricardo’s temperature is 38 degrees centigrade and he has tender enlarged anterior cervical lymph nodes on the left side. He has an enlarged red left tonsil partially covered in white exudate. The right tonsil is also red but not so enlarged. He is breathing and swallowing normally throughout the consultation.

You do not have any access to Ricardo’s past medical history as he has just registered with your practice and he previously lived in Brazil. Ricardo’s sister says that Ricardo has not had serious medical conditions before and has never been allergic to antibiotics.

What are the provisional primary and differential diagnoses?

The following are the peers answers:

PEER 1

Ricardo is a 20-year-old male who comes to the clinic complaining of “a very sore throat and feels very tired”. On assessment I discover patient has had the sore throat for 24 hours with pain on swallowing. Patient has been having fevers of 100.4F/ 38C. Patient has tender enlarged anterior cervical lymph nodes on the left side. His left tonsil is enlarged and partially covered in white exudate. The right tonsil however is red not enlarged. His respiration and swallowing are within normal limits.

Primary Diagnosis

Tonsillitis– Tonsillitis is generally the result of an infection, which may be viral or bacterial. Viral etiologies are the most common. The most common viral causes are usually those that cause the common cold, including rhinovirus, respiratory syncytial virus, adenovirus, and coronavirus. These typically have low virulence and rarely lead to complications. Other viral causes such as Epstein-Barr (causing mononucleosis), cytomegalovirus, hepatitis A, rubella, and HIV may also cause tonsilitis. (Georgala CC,Tolley NS, Narula PA,2014)

Differential Diagnosis

Streptococcus Pharyngitis- infection with Streptococcus pyogenes. Symptom onset in streptococcal infection is usually abrupt and includes intense sore throat, fever, chills, malaise, headache, tender enlarged anterior cervical lymph nodes, and pharyngeal or tonsillar exudate.  (Ebell, Smith, Barry, Ives, & Carey, 2000Shaikh, Leonard, & Martin, 2010).

Viral Pharyngitis-Pharyngitis is an inflammation of the pharynx resulting in a sore throat. Pharyngitis is a symptom rather than a condition. Most often it is caused by viral infections like the common cold and flu. (Pharyngitis, n.d.)

PEER 2

Base on to the descriptions in the case study, Mr. Ortego is a 20 years old heterosexual male with no regular single partner. According to his sister, who interpret for him, he used to live in Brazil, does not speak English, has no past serious medical history and is not allergic to any Antibiotics. He recently came to the clinic complaining of sore throat for the last 24hours. He represent with signs and symptoms of pain when swallowing, no cough, a temperature of 38 degrees Celsius (100.4 degrees), tender and enlarged anterior cervical lymph nodes on the left side, and his left tonsil is red, enlarged and partially covered with exudate, the right tonsil is red but not enlarged, and no difficulty breathing.

Primary Diagnosis:

Tonsillitis:  Mr. Ortego present with signs and symptoms that includes left red swollen tonsil enlarged and partially covered with exudate, sore throat, painful swallowing, fever, and tender and enlarged anterior cervical lymph nodes (Mayo Clinic 2018).

Deferential Diagnosis:

1. Acute Streptococcal Pharyngitis: Due to the patient’s complaints of sore throat for the last 24hrs, and along with fever and swollen lymph nodes and no cough provide reason for this differential diagnosis (Center for Disease control and Prevention 2018).

2. Mononucleosis: Mr. Ortego is heterosexual male with no regular single partner, he presents with sore throat, fever, swollen glands, exudate on the tonsil. Infectious mononucleosis is transmitted by exposure to saliva, so it can be spread by kissing, it is usually caused by the Epstein-Barr virus. It most often affects children, teenagers, and young adults (Ebell 2016).

Whether you agree or disagree explain why with supporting evidence and concepts from the readings or a related experience. Include a reference, link, or citation when appropriate. APA 6th edition format for references as well as in-text citations is expected, but are not mandatory.

THINK ABOUT UNILATERAL TONSILITIS

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