Fever

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍hourday history of fever

Peak temperature recorded: ‍° ‍not measured

Pattern of fever: ‍persistentintermittent

Alleviating factors: ‍noneacetaminophenibuprofenNSAIDs, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍runny nose, ‍clearcolored

‍sore throat

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍body ache

‍joint pain

‍night sweats

‍fatigue

‍rash

‍loss of appetite

‍decreased fluid intake

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍dysuria

‍urinary frequency

‍flank pain



Contributing factors:

‍recent travel

‍similar symptoms in close contacts

‍insect bites

‍unprotected sex

‍risk factors for STIs

no history of: ‍recent infection, ‍HIV, ‍immunodeficiency, ‍malignancies





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Viral infection ‍likelysuspectedpossible

DDx: viral infections, influenza, COVID-19, common cold, streptococcal pharyngitis, pneumonia, urinary tract infection, endocarditis, meningitis, fungal infection (e.g., histoplasmosis, coccidioidomycosis), parasitic infection (e.g., malaria, giardiasis), autoimmune diseases (e.g., lupus, rheumatoid arthritis), malignancy (e.g., lymphoma, leukemia), medication-induced fever, postoperative fever, endocrine disorders (e.g., thyroid storm, pheochromocytoma), heat stroke, inflammatory disorders (e.g., Crohn's disease, ulcerative colitis), deep vein thrombosis, pulmonary embolism, vasculitis, sarcoidosis, familial Mediterranean fever, periodic fever syndromes, vaccine reaction





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍CRP, ‍LFTs, ‍blood culture

- Urinalysis, Urine culture

- Covid test, Influenza test

- Chest X-ray

- Throat swab

Treatments:

- ‍Acetaminophen as needed

- ‍Ibuprofen as needed

- Over-the-counter cold and flu remedies

- Encourage hydration

- Antibiotics

- Avoid contact with others

Further care:

- Follow-up in ‍ ‍hoursdays

- Return if fever persists for more than 3 days, if new symptoms develop, or if condition worsens

- Referral to ER if severe headache, stiff neck, or other signs of serious illness occur