Bad breath and painful swallowing in a boy

Abstract

An 11-year-old boy was admitted with mildly painful swallowing. His parents mentioned he had had bad breath for 4 months. He had presented with the same complaint several times at medical centres, and some antibiotics and analgesics were given. During examination, bad breath (halitosis) was noted (figure 1). There was no cervical and submandibular lymphadenopathy and fever. Figure 1 Oropharyngeal examination on admission. Questions: What do you see on oropharyngeal examination? What is the most likely diagnosis? Tonsillitis with exudate. Tonsillolithiasis. Foreign body on tonsil. Peritonsillar abscess. How would you manage this patient? Start broad-spectrum antibiotic. Drainage. Remove by using swab. Tonsillectomy. Answers can be found on page 2 © Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.