Try your hand at this differential diagnosis!

[ttac]

Alright! (bear with me... I'm almost a second year here, so my medical terminology isn't up to par)

27 y/o male presents with slight, throbbing headache and stuffy nose. Patient complains that he had allergies for a couple of weeks, then got a cold/stuffy nose a week later. He has a sore throat, coughing which is worse at night, and headache upon getting up in the morning. This is the first time he had this condition, as he moved to Philadelphia from San Diego, where he never had allergy problems.

Dx?

ttac
p.s. He is going to make an appointment to see his PCP next week anyway, so this is just for kicks.
p.p.s. Here is my diagnosis in rot-13 text, so as not to bias your diagnosis:

nphgr fvahfvgvf

Use this link to translate it:
http://members.tripod.com/~BraunzGuy/rot13.htm

Seems to match up pretty well with the symptoms given in this link

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Members don't see this ad.

 

[souljah1]

Originally posted by ttac
27 y/o male presents with slight, throbbing headache and stuffy nose. Patient complains that he had allergies for a couple of weeks, then got a cold/stuffy nose a week later. He has a sore throat, coughing which is worse at night, and headache upon getting up in the morning. This is the first time he had this condition, as he moved to Philadelphia from San Diego, where he never had allergy problems.

Dx?

Throbbing headache along with runny nose makes me think of cluster headaches. However, the 'slight' headache isn't a common complaint with cluster headache. Sometimes there will also be infected conjunctiva and maybe even a little Horner's Syndrome. However, my thoughts about cluster headache ceased after reading the next sentence.

The sore throat, coughing worse at night, and headache in the morning - along with the allergies - could be sinusitis or a PND (but the PND doesn't explain the headache). Sinusitis can definitely present with throbbing headaches that are worse in the morning (recumbent) depending on the sinuses involved.

In headaches that are new and worse in the morning, we should also think of elevated intracranial pressure, which seems a bit exteme in his case but I would definitely take a look fundoscopically and look for papilledema. I'd want to know a little bit more about his history, but brain masses are not all that uncommon in a 27 year old man. The lack of focal neurological findings, along with the allergies and the course of the headaches steer away from the ICP, though.

What about an opiate withdrawal syndrome? Hehe, highly doubtful, but something to keep in mind with the rhinorrhea and headache.

Is he febrile? Sputum color? Nasal discharge? Color? When you palpate the sinuses, is there pain? diaphoretic?

That is about all my first year brain can manage on this one.



And if womansurg reads this....post another case for us. They are a lot of fun.

 

[doc05]

hay fever?

 

[ttac]

Originally posted by doc05
hay fever?

...that's probably just the half of it. He definitely had allergies at the beginning (sneezed alot, runny/stuffy nose, etc) but felt just fine. A few days ago, he got a cold and other symptoms. I'm pretty sure it's sinusitis, probably acute:

http://www.msnbc.com/news/796319.asp

ttac

 

[jmejia1]

I agree with Souljah1 with: 1.) Cluster headache and 2.) Sinusitis
as differentials.

Headaches more prominent in the morning would lead to the suspicion of increased intracranial pressure (e.g. brain tumor) if the patient did not present with allergy or sinusitis symptoms.