The patient presents to the emergency department complaining of severe headache and muscle and joint pain that started two days ago. Vital signs are significant for a heart rate of 112 bpm and temperature of 103°F. Upon assessment, the nurse notes a maculopapular rash on the patient’s wrists. Which question is most helpful in determining the cause of this patient’s symptoms?

Question

The patient presents to the emergency department complaining of severe headache and muscle and joint pain that started two days ago. Vital signs are significant for a heart rate of 112 bpm and temperature of 103&deg;F. Upon assessment, the nurse notes a maculopapular rash on the patient&rsquo;s wrists. Which question is most helpful in determining the cause of this patient&rsquo;s symptoms?

Accepted Answer

“Have you noticed any tick bites in the last couple of weeks?”. Severe headache, myalgia, arthralgia, fever greater than 102&deg;F, and a maculopapular rash that begins on the hands and spreads inward toward the trunk in this patient is concerning for Rocky Mountain spotted fever (RMSF). Therefore, asking the patient if he or she had sustained a tick bite recently can confirm the diagnosis. RMSF is not contagious, so asking about exposure to individuals with similar symptoms is not helpful. The patient&rsquo;s symptoms are not consistent with an allergic reaction. It might be helpful to know the patient&rsquo;s travel history, but less helpful than exploring a history of tick bites.

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