Fever

Question 1

What temperature is considered a fever orally and rectally?

Answer 1

> 37.8 degrees Celsius orally or 38.2 degrees Celsius rectally

Question 2

What is the diurnal variation of body temp?

Answer 2

There are diurnal variation in temperatures - app 0.6 degrees Celsius higher in the afternoon

Question 3

What are the red flags in history for fever?

Answer 3

Red Flags (indicates serious bacterial infection)

- Presents within first 24 hours
- Presents 2nd time within short period of time
- Severe muscle pain
- Severe localised pain - Repeated vomiting with no diarrhoea

Question 4

What are the red flags in examination for fever?

Answer 4

Red flags (indicates serious bacterial infection)

- Drop in BP and tachypnoea
- Patient incapacitated (cannot walk, cannot stand)
- Altered conscious state or changed behaviour
- Petechiae: small non-blanching red or purple spot caused by bleeding into skin
- Jaundice - Normal looking throat in a patient with sore throat

Question 5

What are the set of Hx questions that should always be asked in a fever?

Answer 5

• Immunosuppression
  
  • DM and recent poor control (exacerbates immunosuppression)
  • Any foreign body or prosthesis
  • Recent hospitalisation
  • Recent family illness
  • IVDU
  • Sex Hx
  • Recent travel:
    ○ Geographical location
    ○ Setting: rural or urban, and type of accommodation
    ○ Food and Activities
    ○ Sex Hx
    ○ Prior vaccinations
    ○ Malaria prophylaxis
    Fresh and salt water exposure

Question 6

Ix - bloods

Answer 6

• FBE: increase WCC
  
  • UEC: dehydration
  • LFT
  • Glucose
    Plus:
  • ABGs: respiratory alkolosis or resp failure
• CRP

Question 7

Ix - septic screen

Answer 7

Septic Screen

- Blood culture: 3x from three different sites before Abx
- Urine (MSU): MCS
- CXR: pneumonia

Question 8

Ix - other lab tests to consider based on presentation

Answer 8

Other tests:

- Wound sites for surgical patients
- Stools if diarrhoea
- Throat swab
- Serology if suspect viral
- Thin and thick blood films, malaria immunochromatographic (ICT) if suspect malaria - Biopsy of relevant tissue for histology

Question 9

What is macro v micro urinanalysis looking for?

Answer 9

Urinalysis:
A. Macroscopic urinalysis
- Observe colour of urine
○ Cloudy or turbid indicates protein
○ Red indicates drugs, Hb, beetroot juice consumption
- Urine dipstick aka full ward test
○ pH
○ Specific gravity
○ Protein: >150mg/day is considered as proteinuria. Dipstick can only detect amounts > 300mg
○ Glucose
○ Ketones
○ Nitrites indicates presence of bacteria
○ Leukocyte esterase indicates presence of WBC

B. Microscopic urinalysis

- RBC (haematuria)
- WBC (pyurina)
- Casts
- Epithelial cells (sloughing)
- Bacteria
- Yeast

Question 10

If someone presents with a fever, what are the main differentials?

Answer 10

1. Infectious
2. Neoplastic
3. Inflammatory