A 4-year-old boy presented to the hospital with a chief complaint of a painful lump in his neck. He has been complaining of progressively worse pain in his ear for the past few days, but now came to the hospital because of the development of the neck mass. He has been given acetaminophen for pain relief. He has otherwise been a healthy child and attends pre-school. Physical Exam: VS T 37.0, P 100, RR 25, BP 100/60, oxygen saturation 99% in room air. Patient is alert and active, in no distress. He is not toxic and not irritable.
Head and eye exam are normal. Right tympanic membrane is bulging and purulent. His left tympanic membrane is normal. His neck exam demonstrates a fluctuant mass on the right side with overlying cellulitis (redness). His mouth exam shows a normal pharynx, mucosa and good dentition. Heart, lung and abdomen exams are normal. He ambulates normally and…
