Differential Diagnosis

• Single most likely diagnosis
  • Streptococcal pharyngitis: The patient's symptoms of a painful sore throat, white dots on the tonsils, and difficulty swallowing are consistent with streptococcal pharyngitis. The fact that she works in a school system, where streptococcal infections are common, also supports this diagnosis.
• Other Likely diagnoses
  • Viral pharyngitis: The patient's symptoms of a wet cough, sinus congestion, and night sweats could be indicative of a viral infection. The presence of white dots on the tonsils could also be seen in viral infections such as infectious mononucleosis.
  • Acute bronchitis: The patient's symptoms of a wet cough and fullness in the chest, which worsen at night, could be indicative of acute bronchitis.
  • Influenza: The patient's symptoms of chills, night sweats, and headache (HA) could be indicative of influenza, especially given her exposure to children in a school system.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Epiglottitis: Although less likely, epiglottitis is a life-threatening condition that requires prompt diagnosis and treatment. The patient's symptoms of a painful sore throat and difficulty swallowing could be indicative of epiglottitis.
  • Pertussis: The patient's symptoms of a wet cough and night sweats could be indicative of pertussis, especially given her exposure to children in a school system.
  • Pneumonia: The patient's symptoms of fullness in the chest and night sweats, as well as her history of pneumonia, could be indicative of a new pneumonia infection.
• Rare diagnoses
  • Infectious mononucleosis: The patient's symptoms of a sore throat, fever, and night sweats could be indicative of infectious mononucleosis, although this is less likely given her age and lack of other symptoms such as lymphadenopathy.
  • Lemierre's syndrome: The patient's symptoms of a sore throat and difficulty swallowing could be indicative of Lemierre's syndrome, a rare condition characterized by a bacterial infection of the throat and neck.