Differential Diagnosis

Differential Diagnosis

The three differential diagnoses that I will accord to Mary include the ICD 10 code B27.8 which is other infectious mononucleosis as a primary diagnosis. Other diseases to rule out at this stage will be the presence of ICD 10 code B25.9 which indicates Cytomegaloviral disease. I will also eliminate the presence of ICD 10 code J03.9 to establish whether there is acute tonsillitis, unspecified. Infectious mononucleosis is an infection caused by Epstein bar virus and mostly spreads through the saliva (Taylor et al, 2015). The disease is characterized by fever, sore throat and swollen lymph nodes and may sometimes cause splenomegaly. The disease is also characterized by malaise just like Mary is complaining of tiredness it could be from the infection with Epstein Barr virus. Infectious mononucleosis is a clinical syndrome which is comprised of fever, pharyngitis, and adenopathy.

I will order a blood test to rule out the presence of the causative agent and aid in management. I will determine the presence of the humoral and cellular response to the viral infection. The immune system responds to the viral infection and the immune components such as T lymphocytes and natural killer cells which are produced in plenty to control the diseasesaliva (Taylor et al, 2015).. I will also examine the adenoid glands since they sometimes get swollen with an infection by the Epstein Barr virus. I will carry out a focused physical examination of the pharynx and throat to examine whether it is swollen and inflamed as a result of the infection. I will also palpate the lymph nodes to establish whether they are swollen.

Cytomegalovirus is a common virus that affects people of all ages and once a person is infected the disease becomes dormant but may reactivate later in life. Reinfection with different strains of the virus may occur which makes the current state more severe than the original infection. Cytomegalovirus infection may have no symptoms and can disappear on its own without treatment. The symptoms of cytomegalovirus infection include fever, sore throat, fatigue and swollen glands (Lancini et al, 2014). These are the same symptoms that Mary is presenting with as she said that she feels malaise and sore throat which makes it hard for her to swallow. Cytomegalovirus can cause mononucleosis because the signs and symptoms of two conditions are similar.

Cytomegalovirus rarely causes problems in healthy people as it mostly affects the individuals with a lower immunity or those who are pregnant(Lancini et al, 2014). I will order a blood test for Mary to determine whether there is cytomegalovirus in the blood which is causing the symptoms. I will examine the throat to establish whether it is red and swollen from the infection. I will palpate the lymph nodes to see if they are swollen.

Tonsillitis is an inflammation of the tonsils and results from either a bacterial or a viral infection. The disease is characterized by a sore throat and swollen tonsils. A patient experiences difficulty swallowing fever and also lymphadenopathy in the neck (Georgalas, Tolley&Narula, 2014). The infection may be caused by virus and bacteria mainly Streptococcus. The greatest number of tonsillitis is mostly resulting from viral infections such as Epstein Barr virus.  Mary could be suffering from disease given that she complains of a sore throat and complains of malaise and difficulty swallowing.

My focused physical examination to rule out tonsillitis will focus on the examination of the tonsil glands to establish if they are swollen. I will also palpate for other lymphadenopathy around the neck which may accompany the infection. I will also order a blood test to establish the causative organism for the infection.


Georgalas, C. C., Tolley, N. S., &Narula, A. (2014).Tonsillitis. BMJ clinical evidence2014.

Lancini, D., Faddy, H. M., Flower, R., & Hogan, C. (2014).Cytomegalovirus disease in immunocompetent adults. Med J Aust201(10), 578-80.

Taylor, G. S., Long, H. M., Brooks, J. M., Rickinson, A. B., &Hislop, A. D. (2015).The immunology of Epstein-Barr virus–induced disease. Annual review of immunology33, 787-821.