The narrative describes a scenario where a 24-year-old woman with a nearly golf ball-sized mass in her armpit visits a family medicine office. The doctor, who is not directly seeing patients but overseeing residents, is informed about the case. After the resident presents the case, the doctor asks several questions about the patient's health, symptoms, and medical history. The doctor then conducts a physical examination, which aligns with the resident's findings.
The doctor is puzzled by the patient's symptoms and decides to ask about her family history, recent illnesses, injuries, skin rashes, breast symptoms, shaving habits, recent blood work, and vaccines. The patient admits to getting a tetanus shot and an HPV vaccine in the opposite arm, which rules out the possibility of vaccine-induced lymph node swelling.
The doctor then realizes that the patient got her COVID-19 vaccine three days ago, in the same arm where she's experiencing symptoms. The patient confirms this, and the doctor explains that swollen lymph nodes are a common side effect of the COVID-19 vaccine. The doctor then outlines two options for the patient: proceeding with more tests to determine the nature of the mass, or adopting a watchful waiting approach where they monitor the mass over the next two weeks.
The patient decides to go with the second option, and the doctor informs her to return in two weeks. After two weeks, the patient returns, and the doctor confirms that the lymph node is no longer palpable, indicating that it has begun to shrink as expected following the vaccine. The narrative concludes with a victory music, emphasizing the importance of a full history and physical examination in diagnosing medical conditions.
1. The patient is a 24-year-old female with a nearly golf ball-sized mass in her armpit. She had been experiencing this painful mass for about five days, with a pain level of about a four out of 10. The mass had remained the same size since its appearance.
2. The doctor, who is a family medicine specialist, was not directly treating the patient but was overseeing the residents treating her. The residents would present their cases to the doctor, who would then provide feedback and guidance.
3. The resident described the mass as being mobile, round, and well-circumscribed, located below the skin layer. The doctor was trying to distinguish between a suspicious, dangerous mass and one that appeared more benign.
4. The doctor conducted a physical examination of the patient, who was healthy with no known allergies or medications. The patient was experiencing anxiety about the mass.
5. The physical exam revealed some suspicious and benign features, causing the doctor to be confused and worried. The doctor then asked a series of questions about the patient's health history, including family health history, recent illnesses, injuries, skin rashes, breast symptoms, and recent blood work.
6. The patient had received a tetanus shot and an HPV vaccine, but the doctor ruled out a vaccine-induced cause for the lymph node swelling because the swelling should have subsided by that time.
7. The doctor then realized that the patient had recently received a COVID-19 vaccine, which can cause swollen lymph nodes as an intended effect to stimulate an immune response. The doctor informed the patient that this was likely the cause of her lymph node swelling.
8. The doctor and the patient agreed on a plan to monitor the lymph node, expecting it to begin shrinking after two weeks. When the patient returned two weeks later, the lymph node was no longer palpable, and the golf ball-sized mass was gone.