Marie A Savard MD

Solve the Medical Riddle: She Has a Fever, Nausea, Neck Pain, and a Headache, First Week

Editor’s note: Welcome to our thirdAGE feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

We’ll start this week by letting you know what the patient told her PCP and how the doctor proceeded with the examination. Next week, the PCP will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!


The Patient Reports Her Symptoms


Irene, age 54, has had a fever as well as nausea, neck pain, and a headache for the past twenty four hours. She has tried three doses of Tylenol, which has not helped. She feared taking Advil, which sometimes upsets her stomach.

As always in thirdAGE Medical Riddles, the doctor uses the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll learn what Irene told the PCP:

“My husband insisted that I make an appointment to see you thinking I had some type of spring flu. When the weather here in our town outside of Philadelphia finally turned spring-like a couple of weeks ago, we had our first backyard barbecue of the season and continued to grill outside for the past week with great weather. Yesterday, I started feeling feverish and nauseated. I thought maybe I had food poisoning from the grilled burger I had eaten a few nights before, but my husband wasn’t sick and he had eaten the same thing. Anyway, I probably would have gotten sick much sooner if food poisoning were the problem. I only mentioned our barbecue because I can’t think of anything else I’ve done lately that’s different from my usual routine. I should also tell you that I have pain in my neck and a headache. I took some Tylenol but it has not touched my pain or fever. That was also ineffective. My husband started to feel concerned. I doubt that this is anything serious, but he’s a worrier. I want to put his mind at ease. And of course I’d love to start feeling better!”


The doctor, who has cared for Irene for many years, questioned her about any new medication, illnesses in the family or among friends, recent changes at work or recent travel. She said she had not gone away since visiting her son and daughter-in-law in Michigan for Christmas. She said that the neighbors who had come over for the barbecue are not sick and that none of her colleagues at the insurance company where she is a secretary are sick. She has no other symptoms such as rash, light sensitivity, swollen glands, respiratory congestion, diarrhea. She has had minimal liquids and no food during the previous day because of the nausea.