What is the diagnosis and recommended treatment for a 15-year-old male patient presenting with pharyngitis, swelling, difficulty swallowing, and nausea, who has been absent from school due to illness?

Diagnosis: Acute Viral Pharyngitis (Viral Upper Respiratory Tract Infection)

Ang pasyenteng ito ay may viral pharyngitis, hindi bacterial infection, at hindi kailangan ng antibiotics. 1, 2

Rationale ng Diagnosis

Ang clinical presentation ay clearly viral dahil sa:

• Sequential symptom pattern (GI symptoms → fever/constitutional → respiratory) na characteristic ng viral URI 1
• Nausea at pakiramdam masusuka bilang presenting symptoms ay common sa viral infections 1
• 5 days na symptoms (absent kahapon at ngayon, suggesting onset 2-3 days ago minimum) - ang viral URIs typically last 5-7 days 1
• Pharyngeal erythema with swelling pero walang mention ng exudates - bacterial pharyngitis typically presents with tonsillar exudates 1

Hindi ito Group A Streptococcal pharyngitis dahil:

• GAS pharyngitis presents with sudden-onset severe sore throat as PRIMARY complaint, hindi bilang part ng constellation of URI symptoms 1, 2
• Ang presence ng nausea/vomiting at difficulty swallowing suggests viral origin 3, 1
• Walang mention ng tender anterior cervical lymphadenopathy, tonsillar exudates, o scarlatiniform rash na typical ng GAS 3, 4

Medical Assessment/Diagnosis

Diagnosis: Acute Viral Pharyngitis (Viral Upper Respiratory Tract Infection)

Treatment Plan/Recommendation

Symptomatic treatment lang ang kailangan - NO ANTIBIOTICS INDICATED 1, 2

Medications (PhilHealth Konsulta Formulary):

1. Paracetamol 500mg tablet

   • Dose: 500-1000mg every 6 hours as needed for fever/pain
   • Dispense: 20 tablets
   • Duration: 5-7 days
   • Estimated cost: ₱20-40

2. Cetirizine 10mg tablet (for nasal congestion if present)

   • Dose: 10mg once daily
   • Dispense: 7 tablets
   • Duration: 7 days
   • Estimated cost: ₱35-70

Total estimated cost: ₱55-110 (well within ₱300 budget)

Non-pharmacologic measures:

• Adequate hydration
• Rest
• Warm saltwater gargles for throat pain
• Soft diet if swallowing is painful

Return precautions:

• Return if symptoms persist beyond 10 days without improvement
• Return if symptoms worsen after initial improvement
• Return if severe symptoms develop (difficulty breathing, inability to swallow, high fever >39°C persisting >3 days)

1, 2

Medical Certificate

This certifies that patient has been seen and examined today with the diagnosis of: Acute Viral Pharyngitis (Viral Upper Respiratory Tract Infection)

and recommendation of: Rest and symptomatic treatment for 3-5 days. Expected full recovery within 5-7 days.

This medical certificate is issued upon the request of the patient for: excuse from school attendance due to illness. Patient may return to school when fever-free for 24 hours without antipyretics and feeling well enough to participate in school activities.

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Important Clinical Caveat

Antibiotics are NOT indicated dahil viruses ang predominant cause ng pharyngitis, at antibiotic therapy unnecessarily exposes patients to expense and hazards 3. Testing for GAS should NOT be performed when clinical features strongly suggest viral etiology 2. Ang expected duration ay 5-7 days, though symptoms may persist up to 10 days 1.