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Fever Objectives and References

Objectives:


By the end of Family Medicine Clerkship, students will be able to:


1. Perform a focused history and physical exam to determine presence of fever, fever pattern, and associated sx & signs, so as to:

      a. make a determination as to whether a patient truly has/has had a fever, and whether it is acute versus chronic.

      b. identify patients with serious illness:

i.     Demonstrate good understanding of the potential groups of cause of fever

ii.    Infection, malignancy, drugs, environment (sun, heat)

iii.   Important conditions not to miss: endocarditis, meningitis, septicemia 

2. Recognize special groups where fever has different significance or impact (neonates, elderly patients, travel/immigrant issues, under-immunized groups, living conditions, cultural/religious groups, immune-compromised individuals).

3. Propose a plan for appropriate investigation of possible causes, based in the local context.

4. Propose a basic plan of management that includes:

a. Simple at home measures including antipyretics

b. guidance for patients/caregivers on how to access care depending on evolution of illness

5. Propose empiric therapy for the following conditions:

a. AOM

b. UTI/Pyelonephritis

c. Cellulitis


References:


Recommended Resources Addressing the Objectives

Approach to the Adult Patient with Fever of Unknown Origin (6 pages) - excludes children and neonates (not pediatric)

Objectives covered: 1ab, 2 (partial), 3, 4 (partial, not a or b)

http://www.aafp.org/afp/2003/1201/p2223.html

Roth AR, Basello GM. Approach to the adult patient with fever of unknown origin. Am Fam Physician 2003 Dec 1;68(11):2223-2228.

PMID:14677667

Fever and antipyretic use in children (5 pages) - excludes neonates

Objectives covered: 2 (partial), 4ab

http://pediatrics.aappublications.org/content/127/3/580.full.pdf+html

Section on Clinical Pharmacology and Therapeutics, Committee on Drugs, Sullivan JE, Farrar HC. Fever and antipyretic use in children. Pediatrics 2011                 Mar;127(3):580-587.

PMID:21357332

Fever in the Pediatric Patient (16 pages: very comprehensive, only read this to learn about approaching fever in the neonate - the rest is supplementary)

Objectives covered: 2 (partial), 5b

http://www.ncbi.nlm.nih.gov/pubmed/24176480

Wing R, Dor MR, McQuilkin PA. Fever in the pediatric patient. Emerg Med Clin North Am 2013 Nov;31(4):1073-1096.

PMID:24176480

Diagnosis and Treatment of AOM in Children (2008 update) - 2 pages

Objectives covered: 5a

http://www.topalbertadoctors.org/download/365/AOM_summary.pdf

Towards Optimized Practice (TOP). Diagnosis and Treatment of AOM in Children. 2008; Available at: 

        http://www.topalbertadoctors.org/download/365/AOM_summary.pdf. Accessed June/2014, 2014.

No Pubmed ID

Urinary Tract Infections (12 pages: comprehensive approach to diagnosis and treatment of both upper and lower UTIs)
Objectives covered: 5b

http://www.ncbi.nlm.nih.gov/pubmed/23958364

Wang A, Nizran P, Malone MA, Riley T. Urinary tract infections. Prim Care 2013 Sep;40(3):687-706.

PMID:23958364

Cellulitis: diagnosis and management (10 pages: comprehensive, explains cellulitis well; presents topics important for understanding as well as treatment)

Objectives covered: 5c

http://www.ncbi.nlm.nih.gov/pubmed/21410612

Bailey E, Kroshinsky D. Cellulitis: diagnosis and management. Dermatol Ther 2011 Mar-Apr;24(2):229-239.

PMID:21410612

Foundational knowledge

Page 2 of the "Fever and Antipyretic use in Children" article presents a concise, clinically-relevant summary of the physiology of fever)

Additional resources

Top 10 causes of fever in family medicine, plus clinical pearls  (1 page):

Objectives covered: 1b

http://www.ncbi.nlm.nih.gov/pubmed/17872819

Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: fever. Can Fam Physician 2007 Jul;53(7):1202.

PMID:17872819


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