Rosh Pediatrics Practice Exam

The patient presents with petechial lesions on the soft palate. What condition might this finding suggest?

1. Allergic reaction

2. Viral pharyngitis

3. Streptococcal pharyngitis

4. Mononucleosis

The correct answer is: Mononucleosis

Petechial lesions on the soft palate are often associated with viral infections, and one of the most common conditions that presents with this finding is mononucleosis, particularly when caused by the Epstein-Barr virus (EBV). In mononucleosis, these petechiae can occur due to the inflammatory response and the rupture of small blood vessels in the delicate tissue of the soft palate. The presence of these lesions can be a significant indicator for clinicians to consider mononucleosis, especially when accompanied by other symptoms such as fatigue, fever, sore throat, and lymphadenopathy. In contrast, while allergic reactions may cause other manifestations in the oral cavity, they do not typically lead to petechial lesions. Viral pharyngitis can present with various symptoms but is less specific to petechiae on the palate compared to mononucleosis. Streptococcal pharyngitis generally produces other findings such as significant throat pain, swollen tonsils, and potentially a white or yellow coating on the tonsils, rather than the specific petechial presentations found in mononucleosis. Therefore, the distinctive presence of petechial lesions on the soft palate strongly supports the diagnosis of mononucleosis.