Pyrexia (Adult) Flashcards
HPC
Clarify- what do you mean by feverish?
Timeline- how did this symptom start from the beginning
How are you feeling generally- nausea or pain or night sweats
Timing and triggers- does it come and go or is it constant? Anything bring it on
3 main causes of a fever
Infection
Malignancy
Autoimmune/ others
NB- fever is usually due to a self limiting viral infection or uncomplicated bacterial infection. If no cause after 3 weeks and investigations= pyrexia of unknown origin
Systems review for a fever
Cancer- (F)WARJLN
Respiratory- cough, SOB, sputum, haemoptysis
Cardiac- chest pain
GUT- pain on urination, going more frequently, haematuria, unprotected sex with a new partner
Neurological- headache, neck stiffness, rash, vision changes, jaw claudication
GIT- d and v, changes in bowel habit
Tropical- been abroad recently, insect bites
Haematological- bruising more easily, getting lots of infections
DVT- legs swollen, painful or hot
Breast- any lumps or changes
MSK- skin lesions or ulcers, dry eyes and mouth, do hands change colour in the cold
Friends and family
Any of them have infections at the moment
TB
Weight loss, night sweats, lymphadenopathy, haemoptysis
Risks- previous TB, alcoholism, homeless, IVDU, compromised immune system
IE
Malaise and flu like illness, cardiac and embolus phonomenae like SOB/ systemic infractions
Classically, pt goes to dentist (infection into bloodstream occurs), may or may not have pre existing heart condition
Haematological malignancy
Fever, bruising, recurrent infections, anaemia
Drug induced fever
Some patients have drug hypersensitivities
Consider if no other Sx and they developed the fever after starting/ increasing dose of a drug
Patient perspective
Feelings and effect on life
Ideas
Concerns
Expectations - “I understand you have come here for medical advice but is there anything else you were hoping for today”
PMH
HIV
Previous malignancy
Inflammatory conditions
Recent surgery
DH
Any medications and recent changes
Any allergies
FH
Do any conditions run in the family esp. autoimmune disease and malignancy
Have family and friends been unwell recently
SH
Working currently- impact of fever on job
Tell me about home occupants difficulties etc.
Smoking/alcohol/ recreational drugs
Abscesses
May be no localised Sx
Consider if patient has had recent surgery trauma or PMH of diverticulosis
Cancer
Weight loss and cachexia, as well as other red flags
Rheumatoid arthritis
Symmetrical poly arthritis typically affecting small joints
More common in females
Hot swollen tender joints with morning stiffness
Connective tissue disease eg. SLE
Sicca Sx (raynauds, dry eyes, dry mouth) and fatigue Arthralgia, rashes, renal and limb involvement
Vasculitis
Skin lesions, urticaria, oedema, arthralgia, other systemic features
Familial Mediterranean fever
An inherited condition usually in Mediterranean ethnicities particularly subsets of Jewish communities
Recurrent bouts of fever, abdominal pain, pleuritic chest pain, joint pains etc.
Investigations
Bloods- FBC UE LFT TFT ESR CRP serum ferritin HIG screen
Autoimmune screen
Blood cultures
Urinalysis, urine microscopy, culture and sensitivity
CXR
Mantoux test and quantiferon TB gold for TB
CT MRI USS if cancer or abscess suspected (and colonoscopy upper GI endoscopy)
Doppler or echo if cardiac involvement
COVID19
COVID is now a differential for anyone who presents with a fever
Ask about vaccines, loss of sense of taste and smell
May see COVID pneumonitis on an XRay
