Infectious Disease · Model history
Fever, headache, and a stiff neck: a model infectious disease history
- Setting
- Emergency department
- Patient
- Ms. Davis, 29, developed high fever, severe headache, and neck stiffness over eighteen hours and is becoming increasingly drowsy.
- Listen
- 4 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“Yes... I keep losing my train of thought, and it's hard to stay awake.”
Ask directly about seizures or new weakness or numbness, key neurological danger signs.
Have you had any seizures, or any weakness or numbness anywhere?
Model interview
Full transcript
- Doctor
Ms. Davis, I'm Dr. Reyes. I know it's hard to focus right now, but I need to ask you a few questions. Can you tell me what's been happening?
- Patient
My head is pounding, and I feel so sick. It's been getting worse since yesterday.
- Doctor
When did this start, and how quickly did it come on?
- Patient
The headache and fever started about eighteen hours ago, and it's gotten much worse today.
- Doctor
Is it painful to move your neck?
- Patient
Yes, it's stiff and it hurts to move it at all.
- Doctor
Does light bother your eyes right now?
- Patient
Yes, the light is really bothering me.
- Doctor
Have you vomited?
- Patient
Yes, I've thrown up several times, and I felt very sick to my stomach.
- Doctor
Have you noticed any new rash on your skin?
- Patient
I don't think so, but I haven't really looked.
- Doctor
Have you felt more drowsy or confused than usual today?
- Patient
Yes... I keep losing my train of thought, and it's hard to stay awake.
- Doctor
Have you had any seizures, or any weakness or numbness anywhere?
- Patient
No seizures. No weakness that I've noticed.
- Doctor
Have you traveled anywhere recently, or been around anyone who was sick?
- Patient
No travel. My roommate said a friend at work had a bad cold last week.
- Doctor
Have you had any ear infection, sinus infection, or head injury recently?
- Patient
No, nothing like that.
- Doctor
Do you have any other medical conditions, or take any regular medicines?
- Patient
No, I've always been healthy.
- Doctor
Any medicine allergies?
- Patient
No, none that I know of.
- Doctor
Have you ever had your spleen removed, or do you have any condition that weakens your immune system?
- Patient
No, nothing like that.
- Doctor
Do you understand why we need to move quickly and do a spinal tap and give you medicine right away?
- Patient
I think so... my roommate said it could be meningitis, and I just want it treated as fast as possible.
- Doctor
Let me make sure I have this right. Over the past eighteen hours you've developed a high fever, severe headache, neck stiffness, sensitivity to light, and repeated vomiting, and in the last two hours you've become more drowsy and had trouble concentrating. You haven't had a seizure, new weakness, rash, travel, or recent injury. Is that accurate?
- Patient
Yes... that's right.
- Doctor
Thank you for working through this with me. Your symptoms and how quickly they developed are very concerning for a serious infection around the brain and spinal cord. We are not going to wait. We're starting antibiotics and a steroid right now, and we'll do a spinal tap to confirm. Your roommate will also need a short course of preventive antibiotics, since this can occasionally spread to close contacts.
- Patient
Okay... please just help me.
Flow at a glance
The route through the history
- Check alertness while taking the history
- Establish rapid onset over eighteen hours
- Screen for meningeal irritation symptoms
- Ask about vomiting and rash
- Assess level of consciousness directly
- Screen for seizures and focal weakness
- Review exposures, background, and immune risk
- Summarize and start emergency treatment without delay
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
Editorial update: