Lifespan Activity Time: 10 min
Tina’s three-year-old neighbor presents to the clinic with fever, neck pain, headache, and
confusion. He has no
... [Show More] symptoms of an upper respiratory infection. The parents mention
that they do not believe in immunizations. Based on the information given, what diagnosis
is of the greatest concern? What is your next action?
Student Response:
Bacterial meningitis would be the most concerning diagnosis. My next action would be to rule out meningitis by
lumbar puncture and lab work.
Model Note: Bacterial Meningitis needs to be ruled out immediately. He has not had immunizations which
puts him at increased risk for meningitis from Haemophilus influenzae type B. Seizure disorder does not cause
fever. Children with immunodeficiency syndrome are at increased risk for meningitis but this child has no
previous history of chronic infections. Although children with strep throat can present with fever and neck pain,
they are not confused. He needs an immediate spinal tap to determine the nature of the meningitis, and broad
spectrum antibiotics should be started as soon as possible. He should be sent to the emergency room.
Tina’s 83-year-old great uncle forgets where he is during his yearly check-up. He doesn’t
remember if he’s had memory problems before and no family members came to your
office with him. List your differential diagnosis. What assessments would you perform?
Student Response:
Differential diagnosis includes stroke, transient ischemic attack, dementia, infection, electrolyte imbalance,
dehydration and drug toxicity. The provider should do a neurological assessment to rule out stroke and TIA.
Visualization of mucous membranes and skin assessment for tenting is indicated to rule out dehydration. A
urinalysis should be performed to rule out a urinary tract infection which is a common cause of confusion in the
elderly. He should be asked questions about his medication intake and medical history in case he retains some
memory. If he is completely disoriented, family members should be contacted, if possible, to gain more [Show Less]