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- I HAVE A HEADACHE IN THE MIDDLE OF MY FOREHEAD SKIN
- I HAVE A HEADACHE IN THE MIDDLE OF MY FOREHEAD FULL
Patients with ACS are usually anxious and may have a feeling of impending doom. C Chest pain, pressure, or discomfort is the most common symptom of acute coronary syndrome, or ACS (eg, unstable angina, acute myocardial infarction) it occurs in approximately 80% of cases.
I HAVE A HEADACHE IN THE MIDDLE OF MY FOREHEAD SKIN
The remainder of his neurologic and physical examination is unremarkable.TERMS IN THIS SET (100) In addition to chest pain or discomfort, a patient experiencing an acute coronary syndrome would MOST likely present with:Ī: severe projectile vomiting and flushed skin.ī: irregular breathing and low blood pressure.Ĭ: ashen skin color, diaphoresis, and anxiety.ĭ: profound cyanosis, dry skin, and a headache. The mastoid process is nontender and nonedematous.
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The tympanic membranes, ear canals, and periauricular tissues are normal. Using a panoptic ophthalmoscope, you confirm that the retinas appear normal, and the disks are sharp. The pupils are equal, round, and reactive to light. He has mild periorbital swelling.Īlarmed by the history of right-sided vision loss, you perform a thorough eye exam. You palpate a 3 cm × 3 cm, well-circumscribed, skin-colored, fluctuant, tender midline forehead mass. His memory is intact, and his speech is fluent. He is oriented to time, place, and person. His vital signs are within normal range for his age. He is afebrile, with a normal growth curve. The energetic patient runs around the room as though nothing were wrong.
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He has had no fever since hospital discharge. The patient also reports that he wasn't able to see out of his right eye twice that morning. The forehead swelling was noted at bedtime yesterday. The family completed the amoxicillin-clavulanate course 1 week ago, but the patient's headache and photophobia recurred 2 days ago. You are seeing the patient today because his forehead swelling and headaches returned after 3 weeks. An electroencephalogram was found to be normal. The patient has been evaluated on numerous occasions by his primary care pediatrician for the headaches and the fevers and was referred to neurology because of the increased frequency of paroxysmal headaches. Nine weeks ago, the patient began to experience intermittent fevers approximately 3 times per week, with a maximum temperature of 40☌. There have been no changes in gait or baseline energy. They deny cognitive or behavioral regression. By his parents' report, there has been no altered mental status.
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There is no associated nausea or vomiting. The headaches occasionally wake the patient from sleep. For the past 2 months, the headaches have occurred almost daily.
I HAVE A HEADACHE IN THE MIDDLE OF MY FOREHEAD FULL
They begin in the midafternoon and last approximately one-half to 1 full hour. Headaches began 6 months ago and initially occurred twice per week. You further investigate by obtaining a detailed headache history. The headaches and forehead swelling improved. He was discharged home to complete a 21-day course of amoxicillin-clavulanate. The mother says that both the headache and the swelling transiently improved with these interventions. The patient was treated with 4 days of intravenous piperacillin-tazobactam, oral phenylephrine, and nasal oxymetazoline in the hospital. Midline soft tissue swelling was present anterior to the frontal sinuses, but no erosion into these structures was evident. You review the head and sinus computed tomography (CT) scans obtained during the admission and readily appreciate the severe pansinusitis and marked thinning of the lateral walls of the ethmoid air cells.