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HISTORY TAKING OF FEVER. Anamnesis (auto anamnesis and/or hetero anamnesis) Physical Examination Laboratory Analysis Others Diagnostic modalities Differential.

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Presentation on theme: "HISTORY TAKING OF FEVER. Anamnesis (auto anamnesis and/or hetero anamnesis) Physical Examination Laboratory Analysis Others Diagnostic modalities Differential."— Presentation transcript:

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

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

5 History of Present Illness The most important part of history taking The most important part of history taking Use open questions Use open questions Let the patient talk freely Let the patient talk freely Focus or guide on the main problem Focus or guide on the main problem Not interrogative 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) Onset of fever (gradual or abrupt) Quality and intensity Quality and intensity Timing; onset / when it started Timing; onset / when it started Timing.; duration / how long in days, week Timing.; duration / how long in days, week Timing; frequency / how many times in a week Timing; frequency / how many times in a week Any special event when it started / what triggers fever (exercise, only at night time) 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.) Any other accompanying symtoms (sweating, rigors etc.) When was the last time healthy / before any symptoms occurred 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 information of self care and previous medicine taken. Did it help?

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

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

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

12 Abrupt onset, continuous fever Saddle back (dengue) 0123456 35 36 37 38 39 40

13 Continuous fever (typhoid)

14 Febris remittent 37 38 39

15 Intermitent fever (Malaria)

16 Relapsing fever

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

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

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

20 After Anamnesis Prepare list of priorities for physical exam Prepare list of priorities for physical exam Check any records, notes from other doctors Check any records, notes from other doctors Check other info: Check other info: laboratory result, ECG, Chest X-ray  refer to the patient or not 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 Blood pressure Evidence of bleeding in skin or other sites Evidence of bleeding in skin or other sites Hydration status Hydration status Evidence of increased vascular permeability—pleural effusions, ascites Evidence of increased vascular permeability—pleural effusions, ascites Tourniquet test Tourniquet test

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

24 Result


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