3 Beginning of anamnesis Introduce yourself and what are you about to doAsk patient’s identity :NameOccupationDetailed birth-date, address etc.Establish relation, ask with empathy, politely
4 Relationship with patient The patient is the most important person. GIVE ATTENTIONEnsure privacyDO NOT write when patient speaks and needs attention.Take note when he/she finished talking & before next questions, but only VERY BRIEFEstablish relation with anyone else taking care of patientsIf difficulties inc communication, consider need for chaperone or interpreter
5 History of Present Illness The most important part of history takingUse open questionsLet the patient talk freelyFocus or guide on the main problemNot 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 feelHow 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 intensityTiming; onset / when it startedTiming.; duration / how long in days, weekTiming; frequency / how many times in a weekAny 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 occurredTry to visualized mentally the type of feverAdd information of self care and previous medicine taken. Did it help?
9 Add this information History of traveling, residency and neighborhood Previous fever / illnessOccupational historyImmunization historyFamily history
10 Diseases associated with fever Infection : viral, bacterial, fungal, parasiteNon infection : - Malignancy- Trauma- Auto immune- Metabolic, endocrineOthers : heat stroke, drug fever
11 Type of fever to be known Onset of feverType of fever (and timing)Continuous feverRemittent feverIntermittent feverRelapsing fever
12 Abrupt onset, continuous fever Saddle back (dengue) 123456403938373635
17 Others accompanied manifestation Chillsusually with quick/abrupt onset of feverSweatingrelated to the decrease of temperature during cessation of feverHeadacheNon specific accompanying symptomsCan be specific in meningeal diseaseDizziness
18 Others accompanied manifestation Nausea & vomitingNon specific accompanying symptomsRashRelated to viral feverPtechiae, ecchymosis, bleedingMust be suspicious of dengueOthers
19 After anamnesis Closing the session Confirm if there is any other things patient wants to tellWrite information in medical recordConsider your preliminary disease or deferential conclusion
20 After Anamnesis Prepare list of priorities for physical exam Check any records, notes from other doctorsCheck other info:laboratory result, ECG, Chest X-ray refer to the patient or not
22 Physical Examination in Dengue Clinical Evaluation in Dengue FeverBlood pressureEvidence of bleeding in skin or other sitesHydration statusEvidence of increased vascular permeability—pleural effusions, ascitesTourniquet test
23 Torniquete test After takeing blood pressure Inflate blood pressure cuff to a point midway between systolic and diastolicHold pressure for 5 minutesContinuous supervisionPositive test: 20 or more petechiae per 1 inch² (6.25 cm²)