Level 2: Headache – Contrasting Case #2: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient reports his headache has increased in intensity over the past day. He describes the headache as a dull ache; the pain is diffuse and not localized to a specific area. He reports that he has had chills over the past few days. He also says he feels feverish, but has not checked his temperature over the past few days. He also reports difficulty swallowing due to throat pain. He denies any sick contacts; however, he reports he is a principal at an elementary school and there have been quite a few kids missing school due to illness. He denies any nausea or vomiting. He denies any cough or sputum production. He also denies neck stiffness, weakness or paresthesias.

HEENT: Denies dizziness, lightheadedness, or head trauma. Denies changes in vision or hearing. Denies rhinorrhea, epistaxis, or seasonal allergies. Reports throat pain with swallowing.

Physical Exam –
General: Male patient appearance consistent with age. Patient is cooperative and pleasant during interview.
Vital Signs: BP:130/80, P:70, RR:18, BMI:30, T:100.9
HEENT: Normocephalic, atraumatic, PEERLA bilaterally. EOM intact bilaterally. No nuchal rigidity. Negative Brudzinski’s sign. Patient’s posterior pharynx is erythematous with yellow exudates. Patient’s tonsils are enlarged and erythematous.

Tests –
Rapid Strep Antigen: Positive
Throat culture: Numerous colonies of gram positive cocci in chains
CBC: elevated WBC with left shift