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.

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

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