Immediate Questions

A. Does patient have any pain? Pain suggests inflammation and may be seen with infectious causes of neck swelling, including isolated bacterial lymphadenitis and reactive adenopathy and lymphadenitis associated with other head and neck infections (eg, pharyngitis, gingivostomatitis, and peritonsillar, dental, and retropharyngeal abscesses). It is essential to ask about pain in young children because it may affect their overall activity and demeanor and interfere with oral intake.

B. How long has swelling been present? Acute onset is seen with bacterial cervical lymphadenitis (most common cause of lymph node enlargement in children). Gradual onset is seen with atypical mycobacterial infection, tuberculosis, Epstein-Barr virus (EBV), cytomegalovirus (CMV), cat-scratch disease, reactive adenopathy, and malignancies. Intermittent swelling might be seen with congenital cystic lesions, such as thyroglossal duct and branchial cleft cysts. A solitary, swollen lymph node persisting more than 6-8 weeks raises suspicion of malignancy. Has patient had a fever? Fever may be seen with viral and bacterial infections as well as malignancies and other inflammatory processes.

Has any redness been noted? Redness is seen with trauma and infections.

Is patient having difficulty swallowing? Difficulty swallowing secondary to pain and swelling may be seen with pharyngitis, and peritonsillar and retropharyngeal abscesses. Affected patients may have drooling from inability to swallow secretions, and decreased oral intake and dehydration.

What are associated symptoms? Sore throat, drooling, decreased oral intake, and neck stiffness may be seen with retropharyngeal abscess, peritonsillar abscess, and pharyngitis. Constitutional symptoms suggest an infectious, malignant, or other systemic etiology.

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