Solve the Medical Riddle: She Has a Fever, Nausea, Neck Pain, and a Headache, Third 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.

The first week of this riddle, the patient reported her symptoms to her PCP. The doctor proceeded with the examination using 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

Last week, Irene learned the results of a complete blood test and a chemistry panel. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“I was going to say that Irene might have a mild form of meningitis, which I had last year with symptoms similar to hers, but then I read that the neurological exam showed no photophobia and no neck stiffness. When I had viral meningitis, also called aseptic meningitis, my neuro exam did show photophobia and neck stiffness. Because of that, I had an emergency spinal tap to confirm the diagnosis. Irene’s doctor didn’t order a tap, so I’m guessing the doctor ruled out meningitis based on Irene’s neuro exam. I really have no idea what else might be wrong with her!”

— Gabby K.

“Could Irene just have a garden variety gastrointestinal bug? My sister had a GI virus last summer that made her feverish and nauseous. It lasted quite a while. I don’t recall my sister having a headache or neck pain, though, so maybe Irene has something more serious.”

— Maureen Z.

“I’ll bet Irene has Lyme disease. She lives in a suburb of Philadelphia where there are ticks that cause Lyme. I know because I live near Philly and I did get bitten by a tick. Irene was outside for that barbecue, so she may have been bitten in her own backyard. I had the same symptoms she does, and I didn’t have the ‘bull’s eye rash’ that is a giveaway for Lyme disease. Lyme disease is pretty awful, let me tell you! However, there is effective treatment available if the condition is caught early. I’m glad her husband pushed her to go to the doctor sooner rather than later!”

— Alexandra B.

“Maybe Irene has the flu. Did she have a flu shot? The doctor didn’t ask, but he probably has the answer in her chart. This is flu season in Pennsylvania, so that’s my guess as to the diagnosis.”

— Cynthia G.

To be continued . . .

Come back to next Thursday when the doctor will reveal the actual diagnosis and treatment plan.

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

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