History of Present Illness and Examination

A 13-year-old adolescent is sent to the emergency department by his pediatrician for evaluation of fever and a frontal headache, both of which have been present for 6 to 7 days. The pediatrician had prescribed a 5-day course of amoxicillin for a diagnosis of sinusitis1; however, the patient’s symptoms have not improved.  The boy denies current nasal discharge but did have a cold about 3 weeks ago.

Upon examination, his vital signs were normal except for a temperature of 101.1°F.  Physical examination was normal except for a mildly positive jolt sign. Complete blood count and chemistry panel were unremarkable. Influenza testing was negative.

What do the patient’s medical history, examination findings, and test results suggest? What is the next best step in diagnosing this patient?

Click to the next page for answers.