Return to Scenario ListShow Learning Points most relevant to Phase 1:

Fever and headache

Clinical Discipline(s)/Organ System(s)
Infectious Diseases, Microbiology, Intensive Care Medicine, Paediatrics, Nervous System, Neurology
Progress Test Topic(s)
Infectious disease, Seriously ill patient
A 17 year old NZ European man presents with a severe headache and a fever. He was well yesterday and played football after school. On examination he is sleepy, febrile, tachycardic and has neck stiffness.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3 | Question 4
Applied Science for Medicine 
   - Anatomy of the meninges
   - Physiology of septic shock including disseminated intravascular coagulation
   - Microbiology of Neisseria meningitidis and Streptococcus pneumoniae
   - Science of enteroviruses including epidemiology and syndromes
   - Investigation of bacterial meningitis including microscopy and culture, antimicrobial susceptibility testing, polymerase chain reaction (PCR)
   - Principles of immunisation and vaccine preventable disease
   - Pharmacology of penicillins, cephalosporins and vancomycin
Clinical and Communication Skills 
   - History from a patient with
headache and fever
   - Examination of a patient with headache; elicit signs of meningism, neurological examination
   - Recognition of a critically unwell patient
   - Differential diagnosis of meningitis - differentiate bacterial meningitis from self-limiting viral illness
   - Interpret serum electrolytes and renal function tests, blood cultures, cerebrospinal fluid (CSF) biochemistry, CSF microscopy/culture/PCR
   - Importance of early antimicrobial therapy and its influence on microbiological testing
   - Emergency management of the critically unwell patient
   - Prognosis and complications of meningitis
Personal and Professional Skills 
   - Discussion of serious illness with parents, family/whānau
   - Rapid assessment of medical emergencies
Hauora Māori 
   - Appropriate and timely engagement with whānau
   - Awareness of ethnic inequalities in the incidence of infectious disease
Population Health 
   - Epidemiology of N. meningitidis infection in New Zealand
   - Epidemiology of S. pneumoniae infection in New Zealand
   - Awareness of social and demographic determinants of infectious disease
   - Prevention of meningococcal disease
   - Immunisation and vaccination uptake
Conditions to be considered relating to this scenario
bacterial meningitis, viral meningitis, N. meningitidis, S. pneumoniae, viral upper respiratory tract infection, pharyngitis
Less common but 'important not to miss'
herpes simplex virus meningitis, Haemophilus influenzae, Listeria monocytogenes, Mycobacterium tuberculosis
encephalitis, herpes simplex virus encephalitis
Related Scenarios
[Sudden onset severe headache]