Explore the patient’s ideas about the current issue: Explore the patient’s current concerns: Ask what the patient hopes to gain from the consultation: Summarise what the patient has told you about their presenting complaint. Fever was associated with chills and rigors. systemic lupus erythematosus, sarcoidosis, rheumatoid arthritis), Immunosuppressants (e.g. If you'd like to support us and get something great in return, check out our PDF OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. #x203A; Fever is perhaps the most ancient hallmark of disease. Taking a Fever History It is important to take a fever history to distinguish dengu e from other infectious and noninfectious diseases. Adults; Age Temperature What to do; 18 years and up: Up to 102 F (38.9 C) taken orally: Rest and drink plenty of fluids. In contrast, fever of unknown origin is not well defined in children. Ask about the patient’s current occupation to identify any potential exposure to infectious diseases (e.g. diabetes, myeloma, transplant recipient), Autoimmune disease (e.g. This will help ensure your consultation is more natural, patient-centred and not overly formulaic. Ensure you initially keep a comfortable distance, establishing eye contact and rapportwith the family. You can change your ad preferences anytime. Dispose of PPE appropriately and wash your hands. Introduction (WIIPP) Wash your hands; Introduce yourself: give your name and your job (e.g. Alcohol is a significant risk factor for malignancy and impairs immune function. Cardiovascular history ..... 61. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Continue to periodically summarise as you move through the rest of the history. Important associated symptoms that suggest serious illness include poor appetite, irritability, lethargy, and change in crying (eg, duration, character). tuberculosis), Cardiovascular: chest pain (e.g. An inconsistent history should raise the suspicion of a factitious fever or Munchausen syndrome by proxy. Wash your hands and don PPE if appropriate. urinary tract infection, sexually transmitted infection), Central nervous system: headache, photophobia, seizures, confusion (e.g. PUO is defined as fever of 38.3°C or greater for at least 3 weeks with no identified cause after three days of hospital evaluation or three outpatient visits.¹Additional categories of PUO have since been added, including nosocomial, neutropenic and HIV-associated PUO. Gain consent to proceed with history taking. Dr. Louise Gooch, ward doctor) Identity: confirm you’re speaking to the correct patient (name and date of birth) healthcare worker, exposure to animals). breaks in the skin), recreational drug use (intravenous and intranasal), Chemoprophylaxis and compliance (e.g. No public clipboards found for this slide, Approach to history taking in a patient with fever. 2012School of Clinical Medicine Clinical Skills NRMSM UKZN Dr RM Abraham. Ask if the patient has previously undergone any surgery or procedures (e.g. There are many causes. Biomedical perspective- to understand the chronology of symptoms, analyse each symptom and review each system to localize the source of the … [27] The depth of involvement is what differentiates a nodule from a papulePapule-A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in size from a pinhead to less than either 5[28] or 10 mm in diameter at the widest point, Living conditionsIf in squatter’s area-reflect on the lifestyle of Pt, easy transmissibility of other infections due overpopulation within the area, hygiene and cleanlinessIf living near a body of water-especially stagnant water, may bring about the possibility of contracting the disease from vectors for example: mosquitoes (Dengue) Source of water-may indicate if water-borne pathogens have a role in the disease (Typhoid, Cholera)Geographic area of living-Malaria-Saudi (malaria area)/Africa/IndiaBrucella-Saudi/Gulf AreaTyphoid-India/Pakistan/Egypt/IndonesiaHistoplasmosis-USA (West Coast)Tuberculosis, Liver Abscess, AIDS- All over the world, Which countries and regions were visited, arrival and departure datesDetails of living hx including living and sleeping conditions, whether bed nets were used, what type of food and water was consumed and whether there was any contact with animals, hospitals or fresh water.Sexual hx-Unprotected sexual intercourse with a commercial sex worker, 1. culture or PCR), the symptoms the patient experienced and if these have fully resolved, the treatments the patient received and if these were taken as prescribed (e.g. Ask questions about your symptoms and medical history 2. Fever: A rise in body temperature in response to endogenous cytokines. Religion 5. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. contaminated water, animals). does exercise, cold air or pollen make it worse? abscesses, endocarditis, tuberculosis, osteomyelitis), Autoimmune conditions (e.g. Ask if there are any triggers or exacerbating factors for the fever: Ask if anything seems to improve the fevers: Ask if there are other symptoms which are associated with the fever: Ask the patient if they have been recording their fevers and if so what those readings were: Explore the patient’s history for evidence of underlying infectious disease. There is not a single agreed-upon upper limit for normal temperature with sources using values between 37.2 and 38.3 °C (99.0 and 100.9 °F) in humans. Open, relaxed, yet professional body language (e.g. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Accept parental reports of maximum temperature. endocarditis). Closed questions can also be used to identify relevant risk factors and narrow the differential diagnosis. This allows you to check your understanding of the patient’s history and provides an opportunity for the patient to correct any inaccurate information. At this point it is a good idea to find out if the patient has any allergies. Call the doctor if the fever is accompanied by a severe headache, stiff neck, shortness of breath, or other unusual signs or symptoms. Signposting can be a useful tool when transitioning between different parts of the patient’s history and it provides the patient with time to prepare for what is coming next. A review of the prenatal history, including maternal history of sexually transmitted infections (human immunodeficiency virus [HIV], hepatitis B and hepatitis C, syphilis, gonorrhea, chlamydia, herpes simplex), maternal group B Streptococcus(GBS) status and prophylaxis, mode of delivery, prolonged rupture of membranes, and history of maternal fever should be noted. IFN-gamma is produced mainly by T-cells and natural killer cells activated by antigens, mitogens, or alloantigens. hepatitis), Genitourinary: dysuria, frequency, haematuria, urethral discharge (e.g. After taking the history, it's useful to give the patient a run-down of what they've told you as you understand it. A recent study suggests that with modern thermometers, an early morning temperature of greater than 99.0°F or an evening temperature of 100.0°F should be considered abnormal. stairlift), who else the patient lives with and their personal support network, what tasks they are able to carry out independently and what they require assistance with (e.g. Medication isn't needed. HPC- history of presenting complaintPMH- Past medical history, URTI- Upper resp tract infectionLRTI- Lower resp tract infection, Macule – A macule is a change in surface color, without elevation or depression and, therefore, nonpalpable, well or ill-defined,[28] variously sized, but generally considered less than either 5[28] or 10 mm in diameter at the widest point.Vesicle – A vesicle is a circumscribed, fluid-containing, epidermal elevation generally considered less than either 5[28] or 10 mm in diameter at the widest pointNodule – A nodule is morphologically similar to a papule, but is greater than either 5[26] or 10 mm in both width and depth, and most frequently centered in the dermis or subcutaneous fat. uncrossed legs and arms, leaning slightly forward in the chair). Signposting: this involves explaining to the patient what you have discussed so far and what you plan to discuss next. Learn more about viral fever … Ask the patient if they use recreational drugs and if so determine the type of drugs used and their frequency of use. Confirm the patient’s name and date of birth. See our Privacy Policy and User Agreement for details. Introduce yourself to the patient including your name and role. Explain that you’d like to take a history from the patient. History of present illness should note degree and duration of fever, method of measurement, and the dose and frequency of antipyretics (if any). If you continue browsing the site, you agree to the use of cookies on this website. completing a course of antibiotics), close contact with others who were unwell at the time, recent injuries (e.g. Infectious causes of fever after travel could have been acquired before, en route or even after the specific travel, so care with history-taking is important. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. As in any other disease history of the illness is important for a good clinical management. Active listening: through body language and your verbal responses to what the patient has said. HISTORY TAKING IN FEBRILEPATIENTS Using the Calgary Cambridge guide as a framework to interviewing patients. It is also important to ask about any complications associated with the condition including hospital admissions. Characteristic fever patterns of malarial infection are clues for diagnosis. Ask the patient if they’re currently experiencing any side effects from their medication: Relevant medications in the context of PUO include: Ask the patient if there is any family history of cancer or autoimmune conditions: Ask if any of the patient’s close family members currently have any serious infections such as tuberculosis: Explore the patient’s social history to understand their social context. 2. The exact lower cutoff for fever varies from 99.4°F to 100.4°F. Headache, jaw claudication, scalp tenderness, visual loss: suggestive of giant cell arteritis which is associated with polymyalgia rheumatica. Discoloured fingers and toes: may be caused by Raynaud’s phenomenon which is associated with connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Change in bowel habit (including blood in stool), Previous and current infections (e.g. Both arteries and veins are affected. Medical history relevant to PUO includes: Surgical history relevant to PUO includes: Ask if the patient is currently taking any prescribed medications or over-the-counter remedies: If the patient is taking prescribed or over the counter medications, document the medication name, dose, frequency, form and route. Age 3. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. 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