quizzER Vol 1.5

A 43-year-old woman presents to the ED in the state of Michigan with a 1-week history of intermittent headache, nausea, and fatigue. She was seen at her private doctor’s office 1-week ago along with her husband and children, who also have similar symptoms. They were diagnosed with a viral syndrome and told to increase their fluid intake. She states that the symptoms began approximately one week after Thanksgiving. The symptoms are worse in the morning and improve while she is at work. Her BP is 123/75 mm Hg, HR is 83 beats per minute, temperature is 98.9°F, and O2 saturation is 98% on room air. Physical exam is unremarkable. You suspect her first diagnosis was incorrect. Which of the following is the most appropriate next step to confirm your suspicion?
a. Order a mono spot test
b. Perform a nasal pharyngeal swab to test for influenza
c. Consult psychiatry to evaluate for malingering
d. Order a carboxyhemoglobin (COHb) level
e. Order a lead level

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training.

18 Responses

  1. D

  2. D. COhb

  3. D
    Hope you discuss implications of carbon monoxide poisoning for an infant

  4. D. Perform carboxyhemoglobin level

  5. d

  6. D) Order a COHb level…. classic symptoms and story.. location with colder temperatures at the beginning of winter when possibly defective “heating” devices are being used with symptoms that are maximal in the mornings (after being exposed to leaking CO all night) with others in the household affected; and reduction of symptoms during the day (when they remove themselves from that environment).

  7. d. Order a carboxyhemoglobin (COHb) level

  8. D

  9. Check the carboxyhemoglobin.

  10. D

  11. D. Order a carboxyhemoglobin (COHb) level

  12. i think she needs D. Carboxyhemoglobin level
    HA, Nausea that is in several family members and resolves when out of the house…suspicious for CO Toxicity

  13. Order the COHb level

  14. order a carboxyhemaglobin level, this patient has CO poisoning

  15. Carbon monoxide poisioning.

  16. I think D is the correct answer.
    Headache is the first and most common symptom of CO poisoning.
    This diagnosis is suggested by multiple members of the same family affected and by the fact that symptoms improve while the patient is at work.
    Last but not least, her symptoms began approximately one week after Thanksgiving, when the weather is really cold.

  17. […] Last Week’s Question […]

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