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

By Marie Savard MD

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!”

Subjective:

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.

Objective:

A physical exam confirmed that Irene appeared mildly sick and uncomfortable. She had some neck stiffness or pain when she bent her neck forward but no other obvious abnormalities. Her skin, lymph node, and joint exam were all normal. A neurological exam revealed that Irene was alert with no photophobia (extreme sensitivity to light) or pupil or other eye findings. Lung, heart and abdominal exam were normal. She had an oral temperature of 100°, but the Tylenol she had been taking could have lowered her temperature somewhat. Her blood pressure was a bit low and her was pulse a bit high, probably from mild dehydration.

The doctor ordered some blood tests and instructed Irene to increase her fluid intake and continue to avoid solid food for as long as she was feeling nauseated. He asked her to call back in 24 hours for the results of the blood work.

To be continued . . .

Come back to thirdAGE.com next Thursday to learn the results of Irene’s blood work as the doctor continues the quest for a diagnosis . . .

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.