A 5 year old child complains of sore throat and earache. He is pyrexial. Examination: tonsils enlarged and hyperemic, exudes pus when pressed upon. What is the single most relevant diagnosis?

The key is B. Acute follicular tonsillitis. [Tonsillitis is usually caused by a viral infection or, less commonly, a bacterial infection. The given case is a bacterial tonsillitis (probably caused by group A streptococcus). There are four main signs that tonsillitis is caused by a bacterial infection rather than a viral infection. They are:

• a high temperature

• white pus-filled spots on the tonsils

• no cough

• swollen and tender lymph nodes (glands).