Erica P. is an 8 year old girl with swelling on the right side of her neck. Her mother first noticed the swelling about 4 weeks ago and states that it has increased over that time period. Erica had a low grade fever when the swelling first began, but has not had fever in the past few weeks. Erica doesn’t have quite as much energy as she normally does, but has been attending school and participating in her normal activities. Erica complains that the area is sometimes painful. Her mother gave her some of the antibiotics that were left over from treating an episode of strep throat, but there was no improvement.

You look at Erica’s chart and note that you have not seen her in 2 years, and that she has been a fairly healthy child. You have treated her in the past for occasional episodes of otitis media and strep throat. Erica attends 3^rd grade and lives with both her parents, a 5 year old brother, and a 3 year old sister. Her mother is a school teacher, and her father works as a prison guard at the Liberman Correctional Facility. Neither of her siblings have been ill. Influenza has been "going around" Erica’s school, but Erica’s family has been spared (so far).