A patient has a very swollen posterior right side of the tongue. What is the recommended initial diagnosis step?

The recommended initial diagnosis step when confronted with a swollen area on the tongue, such as the posterior right side, is to palpate for firmness and induration. This step is essential as it allows the clinician to assess the characteristics of the swelling. Palpation can reveal important information about the nature of the swelling, such as whether it is soft or firm, which may help differentiate between various potential causes.

For example, a firm and indurated area may suggest a more serious condition such as a fibroma or malignancy, while a softer swelling might indicate an inflammatory cause, such as an allergic reaction or infection. Gathering this tactile information helps guide further diagnostic steps, deciding whether imaging is needed, or if further intervention such as biopsy is warranted.

Immediate intervention with anti-inflammatory medication or observation might not provide the necessary information to make a proper diagnosis and could delay necessary treatment. An incisional biopsy, while sometimes appropriate for definitive diagnosis, is not an initial step without first understanding the characteristics of the swelling through palpation. Thus, starting with palpation allows for a more informed approach to the patient's condition.