Question

A 22 year old woman reported to your health centre with a complaint of fever for 6 days. What questions will you ask the patient in the History of Presenting Complaints?

Answer 1

You don’t even know the definition of Pyrexia and you are up for history taking for fever. You are either doomed or you are not serious really. Have a look below.

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 3
2. 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 meningitis
3. 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, Septicemia, 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, Septicaemia
2. Tertian- Alternate days
   Causes- Benign tertian malaria, Malignant tertian malaria
3. 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 Continuous 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

1. If fever falls to normal within 6-12 hours, it is called Fall by Crisis.
   Causes- Acute lobar pneumonia, Enteric fever with intestinal hemorrhage, Adrenal crisis, Septicemic shock, Dengue, Anti-pyretic drugs
2. 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, Septicemia/Pyaemia, Cholangitis, Sub-acute 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/sub-diaphragmatic abscess, empyema thoracis, empyema of gall bladder), Septicemia/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- Mnemonic- Very Sick Person Must Take Double Tea

• 1st day- Varicella, i.e, Chickenpox
• 2nd day- Scarlet fever
• 3rd day- Pox (Smallpox, not seen these days)
• 4th day- Measles
• 5th day- Typhus
• 6th day- Dengue
• 7th 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.

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.