c) Test for strep, treat if positive only

e) This is likely coxsackie virus, recommend supportive care

f) Check for EBV

• Common causes of pharyngitis in children and adolescents include viral, group A strep (GAS), and EBV (infectious mononucleosis)
• The vesicular lesions make viral herpangina (caused by coxsackievirus) the most likely diagnosis
– Even without the vesicular lesions, testing for GAS before treating is recommended for children, even with high Centor scores, as viral pharyngitis is equally likely as GAS, and antibiotics are not indicated for viral pharyngitis
• Nevertheless, given the presence of exudates, testing for GAS and EBV are indicated
– It is worthwhile testing for these causes as GAS can be treated with antibiotics, and patient education is important for EBV given that symptoms are often prolonged and associated splenomegaly carries risks with contact sports participation
– Treating without testing is not indicated since non-EBV viral pharyngitis is still also a very common cause of these symptoms
– The GAS rapid antigen detection test (RADT) will still detect GAS antigen if infection is active, despite the recent antibiotic therapy