A 26-year-old man presents to the office with a tender mass in his right neck.

A tender, mobile lymph node following a recent localized infection (e.g., dental infection) is most likely reactive. In a young, otherwise well patient with no systemic symptoms or concerning features, observation is appropriate.

Toronto Notes 2023 – Internal Medicine, Lymphadenopathy:

“In patients with localized lymphadenopathy and a recent infection, observation for 4–8 weeks is often appropriate before further investigation.”

MCCQE1 Objectives – Internal Medicine > Hematology:

“Candidates should recognize benign features of lymphadenopathy (tender, mobile, < 2 cm, localized) and manage conservatively unless red flags are present.”

Biopsy (B) and imaging (C, E) are premature. Bone marrow biopsy (D) is not relevant.

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