Section III Common Symptoms (fever)

1
Section III Common Symptoms(fever)

• Dr. Zhuoren Lu
• First Hospital
• Xian Jiaotong University

2
Concepts

• symptoms subjective disturbances, for instance
  headache, chest pain, abdominal pain, dyspnea,
  cough, palpitation, nausea, vomiting, and so on.
• physical signs objective marks, for example
  fever, edema, cyanosis, jaundice, diarrhea,
  confusion, coma, skin eruption, scar, murmur and
  so on.
• In a board sense, both subjective and objective
  abnormal could be called as symptoms.

3
A. Fever (pyrexia)

• 1. Definition Fever represents a disturbance in
  which there is upward shift of the bodys
  temperature.
• lThe normal body temperature taken in the mouth,
  is closed to 37?(36.3?37.2?).
• lOral temperature recordings is approximately
  equal to simultaneous rectal temperature reading.
• ?The temperature of the skin of the axilla is
  slight lower(0.2?0.4?) than that in the mouth.

4

• 2. Physiology An individuals baseline
  temperature varies (less than 1?) (lowest in the
  morning), activity (exercise), physiological
  events (ovulation), and habit (smoking).
• Eldly has lower baseline temperature and often
  produce less fever response.

5
3. Clinical classification

• low fever 37.4?38?
• middle fever 38.1?39?
• high fever 39.1?41?
• excessively high temperature (hyperpyrexia)
  above 41?

6
4. Type of fever

• (1) Continus (persistent) fevers Fever curve
  shows the high temperature from 39?40? may
  continue for days or weeks with fluctuation less
  than 1? between morning and evening (typhoid)

7

• (2) Remittent fevers It is similar to continuous
  fever, but the swing of temperature is greater
  than 2? and the temperature does not fall to
  normal (rheumatic fever).

8

• (3) Intermittent (periodic) fevers The
  temperature rises every second or third day at
  approximately the same time. The temperature
  rises abruptly to about 40? for a few hours only
  and then falls abruptly to normal or
  below(malaria).

9

• (4) Undulant fevers The temperature chart shows
  rises up to 39?40?, lasting for 7?14 days,
  falling to normal for about the same period but
  recurring over many weeks or months.

10

• (5) Relapsing (recurrent) fevers The temperature
  rises abruptly to 39? or above for a few days and
  then falls abruptly to normal (Hodgkins
  disease).

11

• (6) Irregular fevers The fever curve is
  irregular (bronchopneumonia).

12
5. Etiology

• (1) Infections by various infectious agents
  (bacteria, viruses, fungi)the most common causes
  
• (2) Fever frequently occurs in many noninfectious
  illness (most of the cases with low fever),
  including connective tissue disorders,
  hypersensitive reaction, neoplastic diseases,
  hemorrhage, and thromboembolic diseases.

13
6. Symptoms and signs of fever

• (1) Rigor or shivering attack is common at the
  beginning of many fevers.
• (2) Rash, especially in childhood and infectious
  diseases. Also, the various special rashes are
  very important in differential diagnosis.
• (3) Tachycardia In typhoid fever the pulses
  rarely above 110 beats/min in the second week,
  when the temperature may average 40?.