Can you make the diagnosis?

Cheryl is back in the office after taking a few days off with a cold.  She had stayed home with congestion, fever, and cough.  Now she is back at her desk and trying to catch up on her work.  Her cold symptoms have not completely gone away though, and she is keeping a box of Kleenex on her desk for her runny nose.

During the next two days, Cheryl develops a dull headache on her forehead and cheeks.  She starts feeling tired again, like when she had the cold, and notices that her teeth are aching.

What does Cheryl have?

  1.   Sinusitis
  2.   Meningitis
  3.   A migraine
  4.   Pneumonia


If you picked 1.  Sinusitis, you are correct!

Sinusitis can occur after a cold, usually starting with a viral illness.  It can cause thick yellow or green discharge from the nose or down the back of the throat (post nasal drainage).  Sinusitis can cause facial pain or a headache, particularly on the forehead or cheek area.  It can also cause dental pain (from referred nerve pain) and fatigue.

Most people with sinusitis do not need to see a doctor as it will resolve on its own.  However if a patient develops a fever, vision changes, confusion, facial redness, or a stiff neck then they must see a doctor immediately.

Meningitis must always be considered with a headache associated with a viral infection, but in this case Cheryl doesn’t have neck stiffness, vomiting, a rash, or other signs of meningitis.  A migraine is typically associated with a severe headache, visual changes, and vomiting.  Pneumonia symptoms can include a productive cough, shortness of breath, fever, and pain with breathing.


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