HISTORY TAKING OF FEVER

Anamnesis (auto anamnesis and/or hetero anamnesis) Physical Examination Laboratory Analysis Others Diagnostic modalities Differential Diagnosis Working Diagnosis

Beginning of anamnesis Introduce yourself and what are you about to do Ask patient’s identity : Name Occupation Detailed birth-date, address etc. Establish relation, ask with empathy, politely

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

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

Open questions DO ask DON’T 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?

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)

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?

Add this information History of traveling, residency and neighborhood Previous fever / illness Occupational history Immunization history Family history

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

Type of fever to be known Onset of fever Type of fever (and timing) Continuous fever Remittent fever Intermittent fever Relapsing fever

Abrupt onset, continuous fever Saddle back (dengue) 1 2 3 4 5 6 40 39 38 37 36 35

Continuous fever (typhoid)

39 38 37 Febris remittent

Intermitent fever (Malaria)

Relapsing fever

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

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

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

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

Rumpeleede / Torniquete test

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 permeability—pleural effusions, ascites Tourniquet test

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)

Result