18 year old male freshman college student who lives at the dorms at the University of Alabama presents to the urgent care center in the ER at the University hospital where you are the P.A. on duty. He is complaining of a fever and has a headache for about two days. He lives in the dorms there and walked to the hospital you are working at as it was convenient to him and his parents nagged him by phone to get checked out. His history is unremarkable except that he had his appendix removed at age 13. His vitals are normal except for a fever of 101 degrees F. On exam he is a well-nourished and well-developed white male with no visible rashes or lesions. His throat is normal in appearance and he has no sinus inflammation on percussion and palpation. You notice that he has some difficulty in bringing his chin to his chest and when he lays supine he has pain upon a straight leg raise. He has some sensitivity to light as well when using a pen light shined upon his face. His lungs are clear and his heart has normal S1 and S2 sounds. He has no signs of abdominal pain. His labs reveal an elevated wbc of 16,000 with normal being between 3k to 12k. He has more neutrophils on the differential as well (this is known as a left shift). He has no other abnormal labs. Chest x-ray and throat swab for flu and strep are normal. What is your next step? What is your diagnosis? What is the danger here? What bacteria is the most likely given his history and age? This is a very common clinical scenario and you should know it very well going into medical practice. Use what you have learned to answer these questions.
18 year old male freshman college student who lives at the dorms at the University of Alabama presents to the urgent care center in the ER at the University hospital where you are the P.A. on duty. He is complaining of a fever and has a headache for about two days. He lives in the dorms there and walked to the hospital you are working at as it was convenient to him and his parents nagged him by phone to get checked out. His history is unremarkable except that he had his appendix removed at age 13. His vitals are normal except for a fever of 101 degrees F. On exam he is a well-nourished and well-developed white male with no visible rashes or lesions. His throat is normal in appearance and he has no sinus inflammation on percussion and palpation. You notice that he has some difficulty in bringing his chin to his chest and when he lays supine he has pain upon a straight leg raise. He has some sensitivity to light as well when using a pen light shined upon his face. His lungs are clear and his heart has normal S1 and S2 sounds. He has no signs of abdominal pain. His labs reveal an elevated wbc of 16,000 with normal being between 3k to 12k. He has more neutrophils on the differential as well (this is known as a left shift). He has no other abnormal labs. Chest x-ray and throat swab for flu and strep are normal. What is your next step? What is your diagnosis? What is the danger here? What bacteria is the most likely given his history and age? This is a very common clinical scenario and you should know it very well going into medical practice. Use what you have learned to answer these questions.
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