Question

Please Write Succinct: Fever

• Review of Systems: Associated symptoms and Risk Factors
• Findings on Focused Physical Ex
• Five Differential Diagnosis

See example below for question #1:

1. Sore Throat

ROS:

Associated symptoms: fever, redness or eye discomfort, sneezing, wheezing, cough, runny nose, postnasal drip, GERD like symptoms, fatigue, muscle ache, n/v, and diarrhea.

Risk Factors:

Smoking, new sexual partners, irritant exposure, medications, and chronic health problems.

Red flags:

drooling, unable to swallow, unable to lie down, restless, unable to stay still, and unable to talk.

PE findings:

Epiglottis- severe illness with signs of upper airway obstruction such as restlessness, stridor, difficulty breathing, drooling, inability to swallow and high fever signals epiglottis and requires immediate referral. Further examination with a tongue blade could trigger laryngospasms and lead to airway obstruction.

Peritonsillar retropharyngeal abscess- orthopnea, dyspnea, symmetrical swelling, abscess, trismus.

Viral pharyngitis: Erythema, edema of throat, tender posterior cervical nodes.

GAS: temp more than 101.5, exudate anterior cervical lymphadenopathy.

Mononucleosis: presence or absence of pharyngeal exudate, posterior cervical lymphadenopathy, splenomegaly.

Gonococcal pharyngitis: pharyngeal exudate bilateral cervical lymphadenopathy

Inflammation: sinus tenderness, pale or swollen pharynx, postnasal drainage visible, no fever or lymphadenopathy.

Aphthous Stomatitis: shallow ulcers, no vesicles; indurated papules that progress to 1 cm ulcers; ulcer has yellow membrane and red halo; no fever or nodes.

Herpes simplex Lesions: perioral lesions; lymph adenitis; vesicles on palate, pharynx gingiva.

Herpetic pharyngitis: vesicles, ulcers, or exudate of the oral and pharyngeal mucosa.

Candidiasis: curd like white plaques that bleed when scraped off.

Differential diagnosis:

Viral Pharyngitis, Streptococcal Pharyngitis, peritonsillar or retropharyngeal abscess, Mononucleosis, Epiglottis, gonococcal pharyngitis, Herpangina, Vincent angina, Aphthous stomatitis, HSV type 1, Candidiasis, GERD.

Answer 1

FEVER

ROS: Associated symptoms: Sweating, chills and shivering, headache, body ache, myalgia, loss of appetite,irritability, fatigue and dehydration.

Risk factors: Infections due to bacteria or virus, heat exposure like heat stroke and extreme sunburn, dehydration especially in children, inflammatory conditions like rheumatoid arthritis, malignancy, some medications and due to side effect of vaccination.

Physical Examination findings: Body temperature: more than 98.6 degree F Pulse: unequal in the upper extremities especially in diseases like arteritis. Eyes: Roth spots, retinal artery occlusion which is seen in SLE, vasculitis.     Mouth: Oral ulcers which can be seen in SLE, histoplasmosis. Dental abscess, gingivitis, dental caries. Thyroid: Enlarged or tender thyroid as in thyroiditis. Lymphadenopathy: sarcoidosis, SLE, granulomatous infections, hematologic malignancies. Cardiac: Murmur can be heard in bacterial endocarditis. Abdomen: Hepatomegaly as in hepatitis, renal cell carcinoma, hematologic malignancy, liver cancer. Splenomegaly  as in typhoid, tuberculosis, malaria, bacterial endocarditis, Q fever. Sternum: tenderness on palpation as in malignancies especially bone and hematologic.   Vertebrae: tenderness on percussion as in osteomyelitis, tuberculosis, typhoid. Skin: Infected wounds as in surgical site infections. Genitalia: Presence of nodules or swellin as in epididymitis.

Differential diagnoses: Bacterial or viral infections like respiratory tract, urinary tract, gasteroenteritis, endocarditis. Malignancies especially hematologic like leukemia. Autoimmune diseases like SLE, rheumatoid arthritis. Medications, drug or alcohol withdrawal, vaccination.