She is commenced on oral antibiotics (Co-amoxiclav) and a review booked for three days time. At the review appointment the lymph node is felt to have become further enlarged and her fevers continue. She is referred to the Paediatric Assessment Unit.
When Freya arrives on the assessment unit, you undertake a full history and examination.
Apart from a large, non-tender, swelling in the right side of her neck you also find some smaller lymph nodes in her groin, and a mildly enlarged liver and spleen.
Freya’s mother explains that the fevers have been on and off for the last two weeks and despite the antibiotics from the GP, they are not getting any better and she thinks the neck swelling has increased in size.