HISTORY TAKING OF FEVER

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HISTORY TAKING OF FEVER
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Anamnesis (auto anamnesis and/or hetero
anamnesis) Physical Examination Laboratory
Analysis Others Diagnostic modalities Differenti
al Diagnosis Working Diagnosis
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Beginning of anamnesis

• Introduce yourself and what are you about to do
• Ask patients identity
• Name
• Occupation
• Detailed birth-date, address etc.
• Establish relation, ask with empathy, politely

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Relationship with patient

• The patient is the most important person. GIVE
  ATTENTION
• Ensure privacy
• DO NOT write when patient speaks and needs
  attention.
• Take note when he/she finished talking before
  next questions, but only VERY BRIEF
• Establish relation with anyone else taking care
  of patients
• If difficulties inc communication, consider need
  for chaperone or interpreter

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History of Present Illness

• The most important part of history taking
• Use open questions
• Let the patient talk freely
• Focus or guide on the main problem
• Not interrogative

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Open questions
DO ask DONT ask
What is your problem today? Do you have any problem today?
Please tell me what do you feel? Is it fever that you feel
How did this fever start? Did the fever start abruptly?
What happens with the fever on the next day? Did the fever continued at the next day?
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History of Present Illness

• Collected this information
• Onset of fever (gradual or abrupt)
• Quality and intensity
• Timing onset / when it started
• Timing. duration / how long in days, week
• Timing frequency / how many times in a week
• Any special event when it started / what triggers
  fever (exercise, only at night time)

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History of present illness

• Any other accompanying symtoms (sweating, rigors
  etc.)
• When was the last time healthy / before any
  symptoms occurred
• ?Try to visualized mentally the type of fever
• Add information of self care and previous
  medicine taken. Did it help?

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Add this information

• History of traveling, residency and neighborhood
• Previous fever / illness
• Occupational history
• Immunization history
• Family history

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Diseases associated with fever

• Infection viral, bacterial, fungal, parasite
• Non infection - Malignancy
• - Trauma
• - Auto immune
• - Metabolic, endocrine
• Others heat stroke, drug fever

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Type of fever to be known

• Onset of fever
• Type of fever (and timing)
• Continuous fever
• Remittent fever
• Intermittent fever
• Relapsing fever

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Abrupt onset, continuous feverSaddle back
(dengue)






0 1 2 3 4 5 6
40
39
38
37
36
35
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Continuous fever (typhoid)
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39
38
37
Febris remittent
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Intermitent fever (Malaria)
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Relapsing fever
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Others accompanied manifestation

• Chills
• usually with quick/abrupt onset of fever
• Sweating
• related to the decrease of temperature during
  cessation of fever
• Headache
• Non specific accompanying symptoms
• Can be specific in meningeal disease
• Dizziness
• Non specific accompanying symptoms

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Others accompanied manifestation

• Nausea vomiting
• Non specific accompanying symptoms
• Rash
• Related to viral fever
• Ptechiae, ecchymosis, bleeding
• Must be suspicious of dengue
• Others

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After anamnesis

• Closing the session
• Confirm if there is any other things patient
  wants to tell
• Write information in medical record
• Consider your preliminary disease or deferential
  conclusion

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After Anamnesis

• Prepare list of priorities for physical exam
• Check any records, notes from other doctors
• Check other info
• laboratory result, ECG, Chest X-ray ? refer to
  the patient or not

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Rumpeleede / Torniquete test
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Physical Examination in Dengue

• Clinical Evaluation in Dengue Fever
• Blood pressure
• Evidence of bleeding in skin or other sites
• Hydration status
• Evidence of increased vascular permeabilitypleura
  l effusions, ascites
• Tourniquet test

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Torniquete test

• After takeing blood pressure
• Inflate blood pressure cuff to a point midway
  between systolic and diastolic
• Hold pressure for 5 minutes
• Continuous supervision
• Positive test 20 or more petechiae per 1 inch²
  (6.25 cm²)

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Result