Case #89 "An Exertional Headache"
by Charlene Babcock Irvin, MD, FACEP  

A 28 y/o secretary presents with headache. She noted the symptoms were gradual in onset over the past week. The headache is worse when she is walking, and feels better when she is sitting down or lying down. The pain is generalized, described as achy, and not associated with any neurologic symptoms of weakness, blurred vision, etc. The headache is not severe, but seems to be getting worse, and more frequent, so she decided to come and get checked.

ROS: No fevers documented, but she has felt hot and she has had some chills. No nausea, vomiting, but she has been anorexic (2-3 lb wt loss over past week). She has had a sore throat that is mild. Urination and bowl movements are normal. No abdominal pain. She just finished her period, which are usually heavy. No chest pain, but she does have a mild cough (dry), and she does get short of breath when she gets the headaches. This quickly resolves when she rests. No rashes.

PMH: G1P1, no other hospitalizations or medical problems. No surgeries.

SH: No smoking, social alcohol use.

FH: Unremarkable.

Meds: Ibuprofen for headaches.

PE: WDWN thin black female in no acute distress.

VS: HR=110, RR=24, Blood Pressure= 100/50, Temp 99.8F, Sat 95%

HEENT: Pale conjunctiva, otherwise normal HEENT exam. Neck supple.

HEART: RRR, slightly tachy, no murmurs.

LUNGS: Equal breath sounds. Faint rales are heard in RLL.

Abd: Soft, scaphoid, no masses.

EXT: Normal.

Neurologic Exam: Normal motor, sensory, reflex, cranial nerve, mental status, and cerebellar exam.
Questions:

1. What are the classes of anemia and the most common cause?

2. What type of pneumonia could this be, and why doesn’t beta-lactams work on this organism? What can help you diagnosis it? What pattern do you look for on the Chest X-Ray?

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