Differential Diagnosis for 11-year-old Patient
Single Most Likely Diagnosis
- Viral or Bacterial Pharyngitis with Reactive Lymphadenopathy: The patient's symptoms of runny nose, sore throat for 3 weeks, and large lymphadenopathy around the neck suggest a prolonged upper respiratory infection. The abdominal pain could be referred pain from the lower ribs or a result of coughing, which is common in respiratory infections.
Other Likely Diagnoses
- Pneumonia: The sharp pain with coughing and wincing when coughing could indicate pneumonia, especially if the patient has a fever or other respiratory symptoms.
- Gastroesophageal Reflux Disease (GERD): The upper abdominal pain and pain with coughing could be related to GERD, which can cause referred pain to the lower ribs.
- Mononucleosis (Mono): The patient's symptoms of sore throat, runny nose, and lymphadenopathy could be indicative of mono, which can also cause abdominal pain due to splenomegaly.
Do Not Miss Diagnoses
- Pneumothorax: A sharp pain with coughing and wincing when coughing could indicate a pneumothorax, which is a life-threatening condition that requires immediate attention.
- Appendicitis: Although the patient's pain is not localized to the right lower quadrant, appendicitis can present with referred pain to the upper abdomen or lower ribs, especially if the appendix is retrocecal.
- Perforated Viscus: A perforated viscus, such as a perforated ulcer, can cause severe abdominal pain and tenderness, and can be life-threatening if not treated promptly.
Rare Diagnoses
- Lymphoma: The patient's large lymphadenopathy around the neck could be indicative of lymphoma, although this is a rare diagnosis in children.
- Sickle Cell Disease with Vaso-Occlusive Crisis: The patient's abdominal pain and pain with coughing could be related to sickle cell disease, especially if the patient has a history of sickle cell disease or is of African descent.
- Tuberculosis: The patient's symptoms of prolonged upper respiratory infection and lymphadenopathy could be indicative of tuberculosis, although this is a rare diagnosis in children in developed countries.