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S b 15 2010 V l 82 N b 6 f / f A i F il Ph i i 669
A 16-year-old girl presented with fatigue,
weight loss, and dysphagia that began several
months earlier. She had restless sleep lead-
ing to daytime somnolence and poor school
performance, and her family reported loud
snoring. Her medical history was unremark-able, except for recurrent upper respiratory
tract infections.
Physical examination revealed noisy res-
pirations with an open mouth, halitosis, and
tonsillar swelling (see accompanying figure).
She had no fever or lymphadenopathy.
Question
Based on the patients history and physical
examination, which one of the following is
the most likely diagnosis?
A. Bilateral tonsillar abscesses.
B. Hypertrophic tonsils. C. Infectious mononucleosis. D. Tonsill itis.
See the following page for discussion.
Enlarged Tonsils and FatigueMALCOLM LEMYZE, MD, and FAVORY RAPHAEL, MD, Calmette Hospital, Lille, France
The editors ofAFPwel-come submissions forPhoto Quiz. Guidelines forpreparing and submittinga Photo Quiz manuscriptcan be found in theAuthors Guide at http://www.aafp.org/afp/photoquizinfo. To be con-
sidered for publication,submissions must meetthese guidelines. E-mailsubmissions to [email protected]. Contributing edi-tor for Photo Quiz is JohnE. Delzell, Jr., MD, MSPH.
A collection of Photo Quiz-zes published in AFP isavailable at http://www.aafp.org/afp/photoquiz.
Photo Quiz
Downloaded from the American Family Physician Web site at www.aafp.org/afp. Copyright 2010 American Academy of Family Physicians. For the private, noncommercial use
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