AN ABUNDANCE OF OPTIONS

Stage A 33-year-old rancher and outdoorsman reported four days of fever, low back pain, arthralgia, and myalgia. Two days before admission to the hospital, headache, nausea, vomiting, and fever (temperature, 39.7 °C) developed. Response One of the most important first steps in approaching a patient is to frame the problem – that is, to define it in terms of either a diagnosis or a syndrome and then to think about it both pathophysiologically and probabilistically. With this patient, I would frame the problem as an acute undifferentiated fever syndrome. The chief problem is fever of a few days' duration. There… © 1993, Massachusetts Medical Society. All rights reserved.