45Y / F with Neck pain & Fever

Im presenting a case of 45 year old female , House wife , resident of Bhongir came to the opd with 

Chief complaints 

 Neck pain since 10 days 
 Fever since 10 days 

History of present illness 

 Patient was apparently assymptomatic 10 days ago then she developed pain in the left side of neck during ( flexion & extention ).
which was sudden in onset , continuos , which is radiating from occipital region to the shoulders , aggrevated on work and relieved temporarily on medication ( Oils ) 
Patient also complaining of fever high grade , continuous , assosiated with generalized weakness, fatigue , myalgia & headache  , aggrevating as day proggresses and temporarily on taking medication , Fever is not associated with chills or rigors . 
H/o Palpitations 
No H/o Trauma 
 No H/o Nausea vomiting 
No H/o spine tenderness 
No H/o Diplopia
No H/o photophobia 
No H/o Persisitant headache 
No H/o Red rashes 
No H/o altered sensorium , irritability or mental confusion .
No H/o blood transfusions
 
Past History .
K/c/o Hypertension since 4 years and on medication ( Losartan Hydrochlorothiazide 50mg ) 
Not k/c/o DM , TB , BA , CAD, CVA , Epilepsy , Thyroid disorders , bleeding disorders . 
No Past surgical history . 

Personal History 
Diet - Mixed 
Appetite - Normal 
Bladder Bowel - Regular 
Sleep - Decreased since 4 years ( ? Htn ) 
No addictions 
No Drug or food allergies 

Family history 
Patient mother is a k/c/o HTN . 

General examination 

Patient was concious coherent cooperative 

Well oriented to time place person 

Moderately build and nourished

No Pallor. 

Icterus present 

Pedal oedema present 

No cyanosis 

No clubbing 

No koilonychia 

No lymphadenopathy

 JVP - Raised 

Vitals 

Temperature – Afebrile ( 98.6 F )

Pulse rate – 80 bpm , regular 

Respiratory rate – 16 cpm

BP – 140/90 mm Hg 

SPO2 – 98% on room air  

GRBS – 256 mg/dl

SYSTEMIC EXAMINATION

CARDIOVASCULAR SYSTEM

INSPECTION 

Chest is elliptical shaped, bilaterally symmetrical.

Trachea appears to be central 

Movements are equal bilaterally

JVP:Raised 

Visible epigastric pulsations 

 No scars or sinuses

Apical impulse seen in 5th intercostal space lateral to midclavicular line

PALPATION

All the inspectory findings are confirmed 

Trachea is central 

Apical impulse felt at 5th intercostal space lateral to midclavicular line.

AUSCULTATION 

S1 S2 heard no murmurs 

RESPIRATORY SYSTEM 

INSPECTION

Chest is barrel shaped,

bilateral symmetrical.

Trachea is central 

Movements are equal bilaterally

Visible epigastric pulsations 

No scars or sinuses

Apical impulse not seen

PALPATION

All inspectory findings are confirmed: Trachea is central, movements equal bilaterally.

 Antero-posterior diameter of chest >Transverse diameter of chest

Apex beat felt in

PERCUSSION

Resonant note heard in all areas bilaterally

AUSCULTATION

Bilateral air entry present – Normal vesicular breath sounds heard

PER ABDOMEN

INSPECTION 

Shape of abdomen appears to be Normal

No Visible epigatric veins

No engorged veins sinus scars

PALPATION 

All inspectory findings conformed

Abdomen soft & Non tender

No organomegaly

PERCUSSION 

Tympanic note heard all quadrants abdomen

AUSCULTATION

Bowel sounds heard

CENTRAL NERVOUS SYSTEM

HMF - Intact 

Speech – Normal 

Kernigs sign - 

Brudzunski sign - 

Motor and sensory system – Normal 

Reflexes – Normal 

Cranial Nerves – Intact 

Gait – Normal

Cerebellum – Normal  

GCS Score – 15/15

Clinical pictures 




Investigations 


Provisional Diagnosis 
 ? Meningitis 
 ? Cervical radiculopathy 

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