A special thank you to Alexandra Amaducci DO, MBA, FACEP, FACMT for 
organizing this year’s CPC competition during the PACEP26 Scientific 
Assembly. Congratulations to this year’s first place winners – Adam Reed, 
DO from St. Luke’s University Health Network for submitting the case and 
being the resident presenter, and Jiten Patel, MD from Thomas Jefferson 
University for being the attending discussant.
PMHx: seasonal allergies 
PSHx: none
Meds: none
NKDA
Social Hx: UTD on vaccines
VS: HR 125 bpm, BP 136/74 mmHg, RR 22 bpm, 
Spo2 98% RA, Temp 99.8°F
PE:
General: awake, uncomfortable, clutching is head, 
diaphoretic
Neuro: Photophobic, PERRL, gait normal, negative 
Kernig and Brudzinski signs
HEENT: nasal congestion, inflamed nasal 
turbinates, erythematous oropharynx, no obvious 
edema noted to forehead
CV: tachycardic, regular, no m/r/g 
Lungs: CTA b/l 
Abdomen: soft, nontender 
GU: unremarkable
Remainder is unremarkable 
Pertinent Labs:
WBC: 18.93
ANC: 13.90
Platelets: 515
Anion Gap: 16
PACEP SCIENTIFIC ASSEMBLY 2026 CPC HIGHLIGHT
What is the Diagnosis?
A Headache to Remember
7-year-old M presented with facial swelling, headache and neck stiffness x 1 day. Patient 
had a fever at home. Patient was seen the day before for URI symptoms which started 10 
days ago, HA and one episode of vomiting. Patient had improvement with symptomatic 
meds and was discharged home. Over the last 3 days, symptoms worsened and now with 
recurrent vomiting. Parents are concerned that the forehead appears “swollen.” 
CPC CASE 
STUDY
THE CASE
What test will make the diagnosis? 
What is the final diagnosis?
see conclusion on page 26
20
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