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23-year-old male medical student complains of a headache and intermittent…
23-year-old male medical student complains of a headache and intermittent fever for 2 weeks.
Infectious
Local infection
Encephalitis
impaired mental status or have movement or sensory problems, even paralysis
Brain Abscess
papilloedema
focal neurological deficit, may be immunocompromised
Sinusitis
sinus tenderness, reproducible pain on percussion of frontal and maxillary sinuses strongly indicates acute bacterial sinusitis
frontal headache, nasal congestion, mucopurulent nasal discharge, fever; headache aggravated by bending forwards, coughing, or sneezing
Otitis media
bulging, opacified tympanic membrane with decreased mobility; membrane may be white, yellow, pink, or red
presents with otalgia, irritability, decreased hearing, anorexia, vomiting, or fever, usually in the presence of an ongoing viral respiratory infection
Meningitis
neck stiffness, nausea, vomiting, confusion, and a sensitivity to light
nuchal rigidity , rash, joint pains, seizures, or other neurological deficits
Systemic infection
Influenza
Congestion, cough, runny nose, headache, body ache, fever, sore throat, fatigue
Infectious mononucleosis
fever, sore throat, rash, drowsiness, myalgia, loss of appetite; lymphadenopathy, hepatosplenomegaly
Lyme Disease
fever, lethargy, headache, myalgia, neck stiffness, inflammation of large joints; erythema migrans: bulls-eye lesion(s)
Malaria
exposure to endemic area, spiking fevers, shaking chills, sweats, headache, myalgias, malaise, fatigue, nausea, abdominal pain, vomiting, diarrhoea, cough; tachycardia, splenomegaly, jaundice
Rocky Mountain spotted fever
tick bite or known tick exposure, fever, myalgias, headache, nausea, rash; fever, petechial rash, confusion, lethargy
Q fever
fever, rales, pleural effusion, maculopapular rash, hepatomegaly, pulse-temperature dissociation; exposure to livestock, abrupt onset of high-grade fever, self-limiting flu-like symptoms, fatigue, headache, myalgias, dry cough, rash
Tularemia
lymphadenopathy, fever, skin ulcers, pneumonia; from endemic areas or known contact with infected animals or insect vectors, abrupt-onset fever, chills, headache, malaise
Non-infectious
Subarachnoid hemorrhage
severe head pain; loss of vision, double vision, facial weakness, inability to control tongue movement, numbness and tingling or weakness of the arms or legs; Dizziness, nausea, and vomiting
Rheumatic diseases
Sarcoidosis
Tender reddish bumps or patches on the skin, persistent dry cough, fatigue, and shortness of breath
Giant-cell arthritis
localised headache, fever, malaise, jaw pain/claudication, visual loss, throat pain; tenderness over temporal artery, decreased pulse or nodules
Systemic lupus erythematosus
butterfly rash, joint pain, joint swelling, hair loss, headache and lethargy
Brain tumor
may present with unexplained weight loss, focal neurological deficits; hx of cancer; headache that awakens patient from sleep or is present upon awakening, decreases after being awake for several hours, is aggravated by exertion or Valsalva; focal neurological deficits
Pituitary apoplexy (bleeding into or impaired blood supply of the pituitary gland at the base of the brain)
headache, nausea, vomiting, altered mental status; visual deficits: diplopia, ptosis, changes in visual field
Pheochromocytoma (neuroendocrine tumor of the medulla of the adrenal glands)
episodes of headache, palpitations, and diaphoresis; HTN, postural hypotension, fever, retinopathy, tremor, cafe au lait spots if associated with neurofibromatosis