1. HISTORY TAKING OF FEVER

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

3. 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

4. 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

5. 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

6. 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?

7. 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)

8. 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?

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

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

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

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

13. Continuous fever (typhoid)

14. 39 38 37
Febris remittent

15. Intermitent fever (Malaria)

16. Relapsing fever

17. 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

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

19. 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

20. 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

21. Rumpeleede / Torniquete test

22. 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

23. 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)

24. Result