# Medical Case Summary

## 1. Chief Complaint
A 44-year-old male presents with a severe headache, neck stiffness, strong nausea, and fever.

## 2. History of Present Illness
The patient reports a 3-day history of a severe headache, rated 9 out of 10, located at the back of the head, which worsens with light exposure. The headache onset was sudden and is described as unlike any headache the patient has experienced before. Accompanying symptoms include strong nausea and an inability to tolerate light. The patient also reports neck stiffness and difficulty turning the head, which started around the same time as the headache. Fever of 39°C started yesterday. The patient has taken acetaminophen (Parol) with no relief. No recent head trauma, family history of migraines, or significant triggers were identified.

## 3. Past Medical History
The patient is currently taking Metoprolol (Beloc) for an unspecified condition, with no other medications reported. There is no history of chronic diseases, past surgeries, or allergies.

## 4. Physical Examination Findings
Vital signs include a temperature of 39°C, heart rate of 167 bpm, and blood pressure of 189/99 mmHg. The patient exhibits signs of photophobia and reports severe nausea. Neck stiffness is noted, with difficulty in neck movement. No rash or other physical abnormalities were reported.

## 5. Assessment
The patient's presentation of severe headache, neck stiffness, fever, photophobia, and the ineffectiveness of over-the-counter pain relief raises concern for a serious condition such as meningitis. The sudden onset and severity of symptoms, combined with the patient's vital signs, suggest an acute medical condition requiring immediate evaluation.

## 6. Plan
Immediate referral to the emergency department for further evaluation is warranted. Diagnostic testing, including blood tests and possibly a lumbar puncture, should be performed to rule out meningitis or other serious conditions. The patient's current medication, Metoprolol, and its implications in the context of his symptoms should also be considered during evaluation.

## 7. Board Questions Review

### Question 1

A 44-year-old male presents with a 3-day history of severe headache rated 9 out of 10, located at the back of the head, worsened by light, accompanied by strong nausea, neck stiffness, and a fever of 39°C that started yesterday. He reports that acetaminophen (Parol) did not provide relief. He is currently taking Metoprolol (Beloc) for an unspecified condition. Based on this information, which of the following is the most appropriate next step in management?

**Options:**
A. (A) Prescribe a stronger analgesic and advise rest
B. (B) Immediate referral to the emergency department for further evaluation
C. (C) Recommend over-the-counter antiemetics for nausea
D. (D) Advise to continue acetaminophen and monitor symptoms

**Correct Answer:** B

**Explanation:**
The patient's symptoms of severe headache, neck stiffness, fever, and the ineffectiveness of over-the-counter pain relief suggest a possible serious condition such as meningitis. Immediate referral to the emergency department is warranted for further evaluation, including possible lumbar puncture, to rule out meningitis or other serious conditions.

### Question 2

Considering the patient's symptoms and current medication, which of the following conditions is Metoprolol (Beloc) most likely prescribed for?

**Options:**
A. (A) Migraine prophylaxis
B. (B) High blood pressure
C. (C) Anxiety disorder
D. (D) Diabetes mellitus

**Correct Answer:** B

**Explanation:**
Metoprolol (Beloc) is a beta-blocker commonly prescribed for high blood pressure, among other conditions. Given the lack of specific information about a diagnosis but considering the medication's common uses, high blood pressure is a likely condition for which Metoprolol is prescribed in this patient.

### Question 3

The patient reports a fever of 39°C that started yesterday, severe headache, neck stiffness, and sensitivity to sound. Which of the following conditions is most consistent with these symptoms?

**Options:**
A. (A) Tension-type headache
B. (B) Migraine
C. (C) Viral gastroenteritis
D. (D) Meningitis

**Correct Answer:** D

**Explanation:**
The combination of high fever, severe headache, neck stiffness, and sensitivity to sound is highly suggestive of meningitis, a serious condition that requires immediate medical attention. Tension-type headaches and migraines typically do not present with fever and neck stiffness, and viral gastroenteritis would not explain the severe headache and neck stiffness.