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Case
#55 "One Flu Flew Over..."
by Charlene Babcock Irvin, MD
 A
32 y/o teacher presented with abrupt onset
of fever, muscle aches, headache, and sore
throat in late January. The symptoms started
yesterday, and she feels miserable. She
thinks she has the flu (she knows that the
news media has reported that the flu is
going around) and wants that medication to
fight the flu.
PMH: No hospitalizations except delivery (NSVD)
of two children (currently aged 1 years and
3 years). She has not had any influenza
vaccination.
SH: No smoking history; teaches third grade.
Also volunteers as a teacher for special
children on Saturdays.
Meds: Birth Control Pills, and over the
counter (OTC) flu medication.ROS: Fevers
(to 103 at home), sore throat, muscle aches,
cough (non-productive). No abdominal pain,
nausea, vomiting, diarrhea, rashes, or neck
pain/stiffness.
PE: WDWN female, in no acute distress. VS:
Temp: 101.1, RR=18, BP= 128/75
HR: 110 Sat: 100% on room air.
HEENT: Neck supple, TM normal, oropharynx:
minimal erythema, no exudate, tonsils not
enlarged. Neck: No lymphadenopathy
Heart: RRR, HR now 90 (patient received
Tylenol at triage)
Lungs: Clear bilaterally, no rales or
wheezing
Abd: Soft, nontender
Ext: Normal
Neurologic: Normal
1. What are the indications for anti-viral
medication?
2. What is the difference between the
inhaled antiviral medication and the pill
form of antiviral medication?
3. What is the difference between the
inhaled vaccine and the injection vaccine?
4. In the pandemic of 1918, what actually
caused most deaths?
5. What is the current death rate from the
bird flu (avian influenza)?
6. Any lab tests/x-rays necessary for this
patient? Any last minute instructions?
Click here for answers and to respond
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