35yr old asymptomatic patient with incidental finding as shown below. H/O Dypepsia with reflux (+), Vitals WNL, taking oral feeds. Diagnosis and management

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DD Follicular Tonsillitis Diphtheria Infectious mononucleosis Please do a throat swab. Proceed accordingly If patient has symptoms of Tonsillitis , go ahead with Tonsillectomy or just wait and watch.

Follicular tonsillitis DD adherent patches of Candidiasis If unchanged for long time, maybe tonsilloliths.

Follicular tonsillitis . Do throat swab c/s preferably . Diptheria forms a greyish white membrane on tonsils .

Follicular tonsillitis, keratosis pharyngis( if asymptomatic)

Follicular tonsillitis

Follicular tonsillitis

AFT To r/o dyptheria

Tonsillar debris

CONCLUSION Tonsiloliths- B/L Tonsils ( Non-infective) Due to concretions formed by food and desqaumated debris in tonsillar crypts. Mimics tonsillitis, note the Tonsils & Post pharyngeal wall are Not congested. Patient is asymptomatic and incidental finding. Treatment- Reassure Oral hygiene, Mouthwash & gargles. If Halitosis or visually troubling patient, rub/scrape concretions off the Tonsillar crypts. Do explain it can reaccumulate. NO ANTIBIOTICS/ Surgery.

Sirs, Please note that patient is asymptomatic and afebrile with stable Vitals. It's an incidental finding. Please don't go only for the pictures. Expecting some more interesting D/D's...

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