EVER HISTORY TAKING QUESTIONS AND ANSWERS
Previously, we discussed HOW TO TAKE CLINICAL HISTORY- FORMAT. In this blog, we will discover which questions to ask the patient regarding his fever and approach the possible differential diagnosis by revealing more about fever. It is always better to memorize these questions as they are FAQs of medical life. Always try to make patient comfortable and don't hassle or mix up, otherwise it may become cumbersome for both you and patient. The history taking for fever in patients goes as follow:
Q1- Did you suffer any fever recently?
Answer- Yes/No
It is the basic question to approaching chief complaints of patient. Normal body temperature ranges between 98-99 F. However, pyrexia or fever is defined as temperature above 99 F, Hypothermia below 95 F and Hyperpyrexia above 106.7 F. Thermometer is placed for 2 minutes either below tongue in mouth (oral), below armpits (Axillary) or in rectum (Rectal). Preciseness order goes as Rectal>Oral>Axillary.
Q2- Was the fever continuous or just for few hours?
Answer- Continuous/Few hours
Fever is of 3 types:- 1. Intermittent - for several hours, then touches baseline (i.e, normal temp) sometime during day.Causes- See Intermittent fever types in Question 32. Continuous- No fluctuations greater than 1.5 F and never touches baseline.Causes- Lobar pneumonia, Rheumatic fever, Miliary Tb, 2nd week of enteric fever, Meningococcal meningitis3. Remittent- Fluctuations greater than 3 F and never touches baseline (alternate of continuous).Causes- Amoebic liver abscess, Urinary tract infection (UTI), 3rd week of Enteric fever, Acute bronchopneumonia, Acute tonsillitis, Bacteraemia, Septicaemia, Pyaemia.
Q3- Does the fever occur daily or alternate days?
Answer- Daily/Alternate days
Again, it goes as Intermittent type of fever. 3 types of intermittent fever are :-1. Quotidian- Daily Causes- Double infection of P.vivax, Pent-up pus anywhere in body, Tuberculosis, UTI, Septicaemia2. Tertian- Alternate days Causes- Benign tertian malaria, Malignant tertian malaria3. Quartan- 2 days interval Causes- P.malaria-quartan malaria (rare in india)
Q4- Is the fever stable (No fluctuations above 1.5 F) or unstable (Fluctuations above 3 F) and sustained?
Answer- Stable/Unstable
Again, it helps in finding if patient has Continous fever type or Remittent fever type.
Q5- Does the fever falls to normal within 6-12 hours with sweating or it falls to normal gradually over days?
Answer- 6-12 hours/Days
If fever falls to normal within 6-12 hours, it is called Fall by Crisis. Causes- Acute lobar pneumonia, Enteric fever with intestinal haemorrhage, Adrenal crisis, Septicaemic shock, Dengue, Antipyretic drugs
If fever falls gradually over days, it is called Fall by Lysis. Causes- Uncomplicated enteric fever, Rheumatic fever, Acute bronchopneumonia
Q6- Is the fever associated with Chills and Rigors?
Answer- Yes/No
Chills is feeling intense cold, while shivering is Rigor.Causes- Malaria, UTI, Pent-up pus anywhere in body, Septicaemia/Pyaemia, Cholangitis, Subacute Bacterial Endocarditis, Thrombophlebitis, Acute pyelitis/Pyelonephritis, Acute lobar pneumonia, Agranulocytosis, Pyogen reaction (fluid/blood transfusion), Filariasis, Jaundice.
Q7- Is the fever associated with sweating?
Answer- Yes/No
Sweating is associated with Hectic Temperature which is Chills and Rigors followed by profuse sweating and then normal temperature. Causes- Pent-up pus anywhere in body (lung/liver/subdiaphragmatic abscess, empyema thoracis, empyema of gall bladder), Septicaemia/Pyaemia, Advanced TB (rarely)
Q8- Is the fever associated with cold sores on lips?
Answer- Yes/No
Cold sores are painful, tender vesicles on outer surface of lips/Fever blisters on lips.Causes- Acute lobar pneumonia, Influenza, Malaria, Meningococcal meningitis, Weil's disease, Mycoplasma pneumonia infection, AIDS, Physiological- sunlight or menstruation.
Q9- Is there appearance of Rash anywhere during the fever?
Answer- Yes/No
Causes- Mneumonic- Very Sick Person Must Take Double Tea
1st day- Varicella, i.e, Chickenpox2nd day- Scarlet fever3rd day- Pox (Smallpox, not seen these days)4th day- Measles5th day- Typhus6th day- Dengue7th day- Typhoid/Enteric fever
Q10- Is there history of any recent convulsions?
Answer- Yes/No
Pyrexia or fever is generally normal after convulsions (GTCS) due to excessive body muscle contraction. These are short lived (less than 5 mins).
Answer- Yes if any/No
Certain drugs can cause fever, i.e, Pyrexia inducing drugs which are:
Sulfonamides, Phenytoin, Iodides, Bromides, Thiouracils, Barbiturates, Penicillin, Salicylates, Rifampcin, Phenopthalein (used in laxatives), Quinidine.
NOTE: Normal fever generally has Eosinopenia while drug induced fever shows eosinophilia in Differential Leucocyte Count (DLC) of blood.
Q11- What is the drug/medicine history?
Answer- Yes if any/No
Certain drugs can cause fever, i.e, Pyrexia inducing drugs which are :-
Sulfonamides, Phenytoin, Iodides, Bromides, Thiouracils, Barbiturates, Penicillin, Salicylates, Rifampcin, Phenopthalein (used in laxatives), Quinidine.
NOTE: Normal fever generally has Eosinopenia while drug induced fever shows eosinophilia in Differential Leucocyte Count (DLC) of blood.Labels: Fourth year MBBS, Medicine, Top
