Presentation is loading. Please wait.

Presentation is loading. Please wait.


Similar presentations

Presentation on theme: "HISTORY TAKING OF FEVER"— Presentation transcript:


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


Similar presentations

Ads by Google