Solve the Medical Riddle: She Has a Fever, Nausea, Neck Pain, and a Headache, Second Week

By Marie Savard MD

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.

Last week, the patient reported her symptoms. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

Last week Irene presented with fever, nausea, neck pain, and a headache. The doctor ordered blood tests and a chemistry profile to check Irene’s liver for hepatitis, and to check her blood count for infection and anemia. The results of the complete blood count showed low platelets. These are small pieces of blood cells that help wounds heal and prevent bleeding by forming blood clots. Platelets are made in the bone marrow.

Irene’s blood test also showed normal white blood counts and no anemia. Her liver function test was normal.

The doctor also ordered additional special blood chemistry tests called an enzyme-linked immunosorbent assay (ELISA) test that uses antibodies and color change to identify specific substances. He also ordered a Western blot test that can confirm that a positive ELISA test result is not a false positive. Based on Irene’s complete blood count and chemistry profile, and the fact that the doctor was close to making a diagnosis already, he did not order a polymerase chain reaction test (PCR) that is often used to diagnose a number of medical disorders. These special tests take about 24 to 48 hours to be complete.

Come back to thirdAGE.com next Thursday to find out what some people have guessed the diagnosis might be . . .

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 DrSavard.com.