Write a concise HPI for a 45‑year‑old female presenting today with a three‑day history of progressive cough, frontal headache, light‑headedness, and fever, without significant past medical history, no tobacco or illicit drug use, and only occasional social alcohol consumption.

History of Present Illness Template for Adult Female with Cough, Headache, Dizziness, and Fever

For a 45-year-old female presenting with a three-day history of progressive cough, frontal headache, light-headedness, and fever, the HPI should systematically capture temporal progression, associated symptoms, and red-flag features that distinguish common respiratory illness from serious conditions requiring urgent intervention.

Essential Components to Document

Onset and Temporal Progression

• Document the exact onset of each symptom (cough, headache, dizziness, fever) and whether they appeared simultaneously or sequentially over the three-day period 1
• Specify fever pattern: maximum temperature recorded, timing (continuous vs. intermittent), and response to antipyretics 1
• Characterize cough evolution: initially dry versus productive, progression from mild to severe, and whether paroxysmal episodes have developed 1

Cough Characteristics

• Describe cough quality: dry versus productive, and if productive, note sputum color, consistency, and volume 1
• Document paroxysmal features: episodes of uncontrollable coughing, post-tussive vomiting, or inspiratory whooping sound (pertussis consideration if cough >2 weeks) 1
• Timing patterns: worse at night, triggered by cold air exposure, or associated with positional changes 1
• Associated respiratory symptoms: chest tightness, shortness of breath, wheezing, or pleuritic chest pain 1

Headache Characterization

• Location specificity: frontal, temporal, occipital, or diffuse 1
• Severity and progression: mild to severe scale, whether worsening or stable 1, 2
• Quality: throbbing, pressure-like, sharp, or constant 1
• Associated neurological symptoms: photophobia, phonophobia, visual changes, confusion, altered mental status, or focal neurological deficits 1, 2

Dizziness Specification

• Clarify type: light-headedness (presyncope) versus vertigo (room-spinning sensation) 2
• Timing: constant versus episodic, triggered by position changes (orthostatic component) 2
• Associated symptoms: near-syncope, actual syncope, palpitations, or chest pain 2

Critical Red-Flag Symptoms to Assess

• Neurological deterioration: confusion, disorientation, altered behavior, speech disturbances, seizures, or decreased level of consciousness 1, 2
• Meningeal signs: neck stiffness, photophobia, or severe headache (though classic triad appears in <50% of bacterial meningitis cases) 2
• Systemic severity markers: rigors, night sweats, unintentional weight loss, or profound fatigue 1
• Respiratory distress indicators: tachypnea (≥24 breaths/min), oxygen desaturation, or difficulty speaking in full sentences 3

Pertinent Negatives and Risk Factors

• Exposure history: recent travel to endemic areas (tuberculosis, COVID-19), sick contacts, or crowded environments 1
• Medication history: ACE inhibitor use (can cause chronic cough, though timing here makes this less likely) 1
• Smoking status: current, former, or never smoker 1
• Immunocompromise: HIV, immunosuppressive medications, diabetes, or chronic conditions 1
• Recent dental procedures or dental pain: odontogenic sinusitis can progress to serious intracranial complications 4

Functional Impact

• Quantify disability: ability to perform daily activities, sleep disruption, missed work days 1
• Symptom interference: eating, drinking, or speaking limitations 1

Clinical Decision Points Embedded in HPI

The HPI should guide immediate triage decisions:

• If fever + headache + any altered mental status or focal neurological signs: this constellation requires immediate neuroimaging before lumbar puncture and empiric antibiotics (ceftriaxone 2g IV q12h + vancomycin 15-20 mg/kg IV q8-12h + acyclovir) without delay, as bacterial meningoencephalitis mortality increases significantly with treatment delays 2, 4

• If vital signs show tachycardia (≥100 bpm), tachypnea (≥24 breaths/min), or fever ≥38°C: obtain chest radiography to rule out pneumonia 3

• If cough is paroxysmal with post-tussive vomiting or inspiratory whoop: consider pertussis and obtain nasopharyngeal culture, though at 3 days duration this is less likely (pertussis typically >2 weeks) 1

• If progressive headache with neurological deterioration over days: this pattern suggests intracranial extension of infection (brain abscess or meningitis) requiring urgent CT head followed by MRI with contrast if CT negative 2, 4

Common Pitfalls to Avoid

• Do not dismiss the absence of neck stiffness: the classic meningitis triad (fever, neck stiffness, altered consciousness) appears in <50% of cases 2
• Do not delay antibiotics for diagnostic testing: if meningoencephalitis is suspected, administer antibiotics immediately before neuroimaging or lumbar puncture 2, 4
• Do not overlook odontogenic sources: recent dental pain or procedures can lead to sinusitis progressing to brain abscess 4
• Do not assume "just viral": COVID-19 can present with cough, fever, and headache, with neurological manifestations (confusion, agitation) occurring in up to 84% of severe cases 1

Sample HPI Structure

"45-year-old female with no significant past medical history presents with 3-day history of progressive symptoms beginning with [specify first symptom and exact timing]. Fever to [maximum temperature] °C, [pattern: continuous/intermittent], [response to antipyretics]. Cough is [dry/productive with sputum description], [paroxysmal/continuous], worse [timing], associated with [chest tightness/dyspnea/hemoptysis or absence thereof]. Frontal headache [severity scale], [quality], [progression pattern], without photophobia, neck stiffness, or visual changes. Light-headedness described as [presyncope/vertigo], [constant/positional], without syncope or palpitations. Denies confusion, altered mental status, focal weakness, numbness, speech changes, or seizures. No recent travel, sick contacts, or known COVID-19 exposure. Non-smoker, no ACE inhibitor use. No recent dental procedures or dental pain. Able to perform activities of daily living but reports [specific functional limitations]. Vital signs on presentation: [document all vital signs including oxygen saturation]." 1, 2