Questions received from peers:
Does the pt have a history of migraines?
Did the pt fall and hit her head? Was her head palpated? Is the patient currently taking any prescription medications? Does the pt have a stiff neck? Are the pt's vaccinations up to date? How many episodes of emesis? What is the composition of the vomit? |
Was the pt recently ill? What had she been eating the day before?
Is the optic nerve damaged? Is there any family history of illness? Did pt's mother mention any muscle/joint pain or pain behind the eyes? Is there any skin rash present on the pt? |
Diagnoses received from peers:
“We suspect that this patient has Meningitis.”
“With the nausea, vomiting, and fever it is possible that this patient has food poisoning.”
“We have determined that this pt is likely to have bacterial meningitis.”
“Differential Diagnosis: HSV Encephalitis or other viral encephalitis.”
“Meningitis with possible Septicemia.”
“The child is exhibiting SVT or supraventricular tachycardia, due to the super high heart rate of 136. Possibly the child has meningitis due to the neck stiffness, headache, nausea, headache, and fever.” (Note: SVT is typically defined as a HR >150.)
“I suspect this patient is suffering from encephalitis caused by a bacterial infection.”
“We believe that the patient has a bacterial infection that is causing her symptoms.
“The patient’s history and current complaints suggest that she is suffering from bacterial meningitis or encephalitis.”
“Lyme disease: Explained from the recent camping trip because a she was most likely bitten by a tick at some point on this trip that was carrying the disease. Explains the headache, vomiting, and muscle pain.”
“The patient is 7 years old thus it is difficult for children to localize pain, so her complaints and symptoms were taken very generally, thus we diagnose her with meningitis.”
“Ddx: Aseptic Meningitis.”
ANALYSIS OF THE DIAGNOSES
A majority (9/12) of the groups diagnosed our patient with Meningoencephalitis, though none guessed that it was amoebic instead of viral or bacterial. Many of those who got the diagnosis cited signs and symptoms such as stiff neck, headache, high temperature, and leukocytes counts when supporting the diagnosis. Of those who erred, one said Bacterial Infection. which is a reasonable mistake to make. Another said Lyme Disease, taking into account the patient's history of camping. They were the only group to do so. Finally, one group said Food Poisoning, taking into account only the nausea, vomiting, and fever, but not the headache or CT results.
“With the nausea, vomiting, and fever it is possible that this patient has food poisoning.”
“We have determined that this pt is likely to have bacterial meningitis.”
“Differential Diagnosis: HSV Encephalitis or other viral encephalitis.”
“Meningitis with possible Septicemia.”
“The child is exhibiting SVT or supraventricular tachycardia, due to the super high heart rate of 136. Possibly the child has meningitis due to the neck stiffness, headache, nausea, headache, and fever.” (Note: SVT is typically defined as a HR >150.)
“I suspect this patient is suffering from encephalitis caused by a bacterial infection.”
“We believe that the patient has a bacterial infection that is causing her symptoms.
“The patient’s history and current complaints suggest that she is suffering from bacterial meningitis or encephalitis.”
“Lyme disease: Explained from the recent camping trip because a she was most likely bitten by a tick at some point on this trip that was carrying the disease. Explains the headache, vomiting, and muscle pain.”
“The patient is 7 years old thus it is difficult for children to localize pain, so her complaints and symptoms were taken very generally, thus we diagnose her with meningitis.”
“Ddx: Aseptic Meningitis.”
ANALYSIS OF THE DIAGNOSES
A majority (9/12) of the groups diagnosed our patient with Meningoencephalitis, though none guessed that it was amoebic instead of viral or bacterial. Many of those who got the diagnosis cited signs and symptoms such as stiff neck, headache, high temperature, and leukocytes counts when supporting the diagnosis. Of those who erred, one said Bacterial Infection. which is a reasonable mistake to make. Another said Lyme Disease, taking into account the patient's history of camping. They were the only group to do so. Finally, one group said Food Poisoning, taking into account only the nausea, vomiting, and fever, but not the headache or CT results.
Photo of the face structure of Naegleria Fowleri. Taken from The National Geographic website.