NBME 7: Diphtheria vs EBV

[Episome]

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Hey, this seem a little dumb, but for anyone who took NBME 7, how can we differentiate between Diphtheria and EBV? The question stem describes a patient with a fever, nonproductive cough, sore throat, general malaise, and anorexia, as well as exudative pharyngitis with a white membrane, prominent cervical lymphadenopathy, and splenomegaly. Is splenomegaly literally the only hint that this is EBV and not Diphtheria? Looking at other resources (such as medbullets (Corynebacterium diphtheriae - Microbiology - Medbullets Step 1)), it seems like an almost picture-perfect description of diphtheria, apart from myocarditis and arrythmias, but these are not seen in all cases.

 

[giraffesayshi]

The epidemiology... Diphtheria is almost nonexistent in the USA, so there would need to be something about the patient not being vaccinated or from a foreign country. And yes the splenomegaly and probably the age (teenager) of the patient gave it away.