What is the best course of action for a 19-year-old female (19 YOF) with painful swelling on the left side of her neck, constant pain worsened by swallowing, and a recent history of fever and cold symptoms, currently taking Tylenol (acetaminophen) and Advil (ibuprofen) for pain management?

Immediate Imaging and Specialist Referral Required

This 19-year-old female with unilateral neck swelling, odynophagia (pain with swallowing), and recent upper respiratory infection requires urgent contrast-enhanced CT of the neck and otolaryngology consultation within 24-48 hours to rule out deep neck space infection or other serious pathology. 1

Critical Risk Assessment

This patient meets multiple high-risk criteria that mandate urgent workup:

• Mass present >24 hours with progressive worsening - the swelling started last night and worsened throughout today 1
• Painful swelling with dysphagia - constant pain worse with swallowing suggests potential deep neck space involvement 1
• Recent infection history - fever earlier this week followed by cold symptoms creates concern for suppurative complications like peritonsillar abscess, parapharyngeal abscess, or lymphadenitis 1

Immediate Management Steps

Do NOT prescribe empiric antibiotics before imaging

• Avoid prescribing antibiotics without clear signs of bacterial infection and imaging confirmation, as this can delay diagnosis of serious conditions including malignancy or abscess requiring drainage 1
• While infection is likely given the clinical context, imaging must come first to guide appropriate treatment

Order contrast-enhanced CT neck immediately

• CT with IV contrast is the gold standard for evaluating neck masses and identifying deep space infections, abscesses, or other pathology 1
• This imaging will differentiate between reactive lymphadenopathy, abscess formation, or other concerning etiologies

Continue current pain management temporarily

• Acetaminophen and ibuprofen are appropriate for pain control and can be continued 2, 3
• The combination of acetaminophen plus ibuprofen provides superior analgesia compared to either agent alone 4, 5
• Acetaminophen 650-1000 mg every 6 hours (maximum 4g/24 hours) plus ibuprofen 400-600 mg every 6-8 hours is reasonable 2, 3

Red Flags Requiring Emergency Department Evaluation

The patient should go to the ED immediately if any of these develop:

• Difficulty breathing or stridor - suggests airway compromise from abscess or edema 1
• Inability to swallow secretions or drooling - indicates severe dysphagia 1
• High fever >101°F - suggests active infection requiring urgent intervention 2
• Trismus (difficulty opening mouth) - suggests parapharyngeal or masticator space involvement 1
• Voice changes or "hot potato voice" - indicates peritonsillar involvement 1

Why This Cannot Wait

Given the patient's age and progressive symptoms, the safest approach is to treat this as high-risk and proceed with imaging and specialist evaluation urgently 1. While reactive lymphadenopathy from recent viral illness is possible, the severity of pain, unilateral presentation, and rapid progression warrant ruling out:

• Deep neck space abscess (retropharyngeal, parapharyngeal, peritonsillar)
• Suppurative lymphadenitis requiring drainage
• Less likely but serious: malignancy (though age makes this less probable)

Common Pitfall to Avoid

The most dangerous error is assuming this is simple viral lymphadenopathy and prescribing antibiotics without imaging 1. If an abscess is present, it requires drainage - antibiotics alone will fail. If malignancy is present (rare at this age but possible), antibiotic treatment delays diagnosis and worsens outcomes 1.