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, 2000; Shaikh, Leonard, & Martin, 2010).