Enlarged tonsils and fatigue.

Volume 82, Number 6 www.aafp.org/afp American Family Physician 669 A 16-year-old girl presented with fatigue, weight loss, and dysphagia that began several months earlier. She had restless sleep leading to daytime somnolence and poor school performance, and her family reported loud snoring. Her medical history was unremarkable, except for recurrent upper respiratory tract infections. Physical examination revealed noisy respirations with an open mouth, halitosis, and tonsillar swelling (see accompanying figure). She had no fever or lymphadenopathy. Question Based on the patient’s history and physical examination, which one of the following is the most likely diagnosis?