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Bad breath and painful swallowing in a boy
  1. Selçuk Yüksel1,
  2. Deniz Gül Zorlu2,
  3. Bayram Özhan3
  1. 1 Department of Pediatric Rheumatology and Pediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
  2. 2 Department of Family Medicine, Pamukkale University School of Medicine, Denizli, Turkey
  3. 3 Department of Pediatric Endocrinology, Pamukkale University School of Medicine, Denizli, Turkey
  1. Correspondence to Professor Selçuk Yüksel, Pamukkale Universitesi Tip Fakultesi Hastanesi Cocuk Nefroloji Poliklinigi, Denizli 20070, Turkey; selcukyuksel.nephrology{at}

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An 11-year-old boy was admitted with mildly painful swallowing. His parents mentioned he had had bad breath for 4 months. He had presented with the same complaint several times at medical centres, and some antibiotics and analgesics were given. During examination, bad breath (halitosis) was noted (figure 1). There was no cervical and submandibular lymphadenopathy and fever.

Figure 1

Oropharyngeal examination on admission.


  1. What do you see on oropharyngeal examination?

  2. What is the most likely diagnosis?

    1. Tonsillitis with exudate.

    2. Tonsillolithiasis.

    3. Foreign body on tonsil.

    4. Peritonsillar abscess.

  3. How would you manage this patient?

    1. Start broad-spectrum antibiotic.

    2. Drainage.

    3. Remove by using swab.

    4. Tonsillectomy.

Answers can be found on page 2


Question 1

Oropharyngeal examination reveals …

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  • Contributors SY conceived of the presented idea, and DGZ encouraged. All authors discussed the results and contributed to the final manuscript. SY and DGZ wrote the manuscript with support from BÖ. BÖ helped supervise the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.