Sick Day

...I'm afraid it's the chair (all day) for Mullberry...

Identifying data: Mrs. Mullberry Whine is a 20-something female medical student who presents for evaluation of sore throat, productive cough, and fever x1day.

Chief Complaint:  “My throat is killing me – listen to how funny my voice sounds!”

History of the Present Illness:  Ms. Whine was in her usual state of decent health when one day prior to presentation she developed sore throat.  Later that evening, she experienced cough productive of non-bloody yellow-green sputum, low grade retrobulbar headache, diffuse myalgias, chills, and a fever of 101.2 per oral thermometer.   She further reports mild nausea, non-bloody loose stools (bristol scale 6) without mucous x5 this am, and poor appetite.  She denies vomiting, nasal congestion or discharge, redness, itching, or discharge of the eyes, rash, chest pain or shortness of breath, dysuria, urinary frequency, or change in color/quality of urine.  Of note, she has been working nights on the peds pulmonary and GI teams for the last week and has been in contact with multiple patients known to be infected with influenza A/B, human parainfluenza virus, human metapneumovirus, adenovirus, rhinovirus, and/or respiratory syncyitial virus.

[Skipping Past Medical History (too interesting), Past Surgical History (too boring), Allergies (none at all, thank goodness, except that pesky one to stupid people), Immunizations (yes, they are ALL up to date), Medications (I need a pill box to keep ’em straight), Family History (leave my mother out of this!), Social History (well rounded), Review of Systems (negative but for those listed in the HPI), Physical Exam (where you goin’ with that tongue depressor, mister?!), Lab Results (ouch, gag), and Imaging straight to – ]

Assessment: Mrs. Whine is a 20-something female with a one day history of  symptoms and physical exam findings consistent with and sick contacts to support acute viral URI.

Plan:

• Pharyngeal swabs for Flu A&B, HPIV, HMV, adenovirus, rhinovirus, and RSV sent to lab.  Rapid strep test and rapid flu test in office negative.
• Rx Oseltamivir (Tamiflu) pending viral swab results.
• Encourage PRN tylenol for pain and fever (not to exceed 4 grams), increased fluid intake, and rest (preferably in a soft, bright papasan).
• And no going to work to spread her nasty germs to already sick kiddos.