04-01-2008, 11:37 AM
A 16-year-old girl is brought to the physician because of
œswollen glands on the neck that were first noticed 3
days earlier. The girl is otherwise feeling well and denies
sore throat, fever, chills, and headaches.Her past medical
history is unremarkable, and she does not take any medications
on a regular basis. The family history is also noncontributory
and no other family members have similar
disease. On physical examination the patient does not
seem to be in any acute distress. Her vital signs are within
normal limits. On the right side of her chin three faintly
pink 3-mm papules are noted.When specifically questioned
about the papules she reports that these œpimples
arose a couple of weeks earlier after her pet kitten
scratched her, but that they are now almost resolved.
Inspection of the neck is significant for marked swelling
of the right side below the jaw line, and palpation reveals
enlarged, tender, mobile lymph nodes in that area.Which
of the following studies is indicated at this time?
(A) Nasopharyngeal swab for culture
(B) Needle biopsy of the lymph nodes
© No further studies are indicated
(D) Radiography of the head and neck
(E) Serum antibody titers
œswollen glands on the neck that were first noticed 3
days earlier. The girl is otherwise feeling well and denies
sore throat, fever, chills, and headaches.Her past medical
history is unremarkable, and she does not take any medications
on a regular basis. The family history is also noncontributory
and no other family members have similar
disease. On physical examination the patient does not
seem to be in any acute distress. Her vital signs are within
normal limits. On the right side of her chin three faintly
pink 3-mm papules are noted.When specifically questioned
about the papules she reports that these œpimples
arose a couple of weeks earlier after her pet kitten
scratched her, but that they are now almost resolved.
Inspection of the neck is significant for marked swelling
of the right side below the jaw line, and palpation reveals
enlarged, tender, mobile lymph nodes in that area.Which
of the following studies is indicated at this time?
(A) Nasopharyngeal swab for culture
(B) Needle biopsy of the lymph nodes
© No further studies are indicated
(D) Radiography of the head and neck
(E) Serum antibody titers