Table 2

 lists the subjective and objective information which needs to be elicited from the patient presenting with fever

How long has the temperature been present?Measure vital signs.
Is it constant or does it fluctuate? Have there been any episodes of ‘hot and cold’ shivers?Take the temperature. If the fever seems very mild and the patient reasonably well then the back of your hand applied to the patients forehead in a ‘hot/not hot’ assessment is acceptable. If the fever seems significant or the patient looks ill then a more objective measurement is mandatory. This may be best provided by an electronic tympanic membrane temperature thermometer though there has been recent debate on their reliability.
Has any medication been taken to help it? If so what was it, how much was taken and how long ago? Did it work?Is there a rash – is it diagnostic of anything? Chickenpox blisters and non blanching purpuric rashes are generally the only ones to be reliable as indicators of a specific cause.
Associated symptomsIs there muscle tenderness?
Do they have any pain or swellings anywhere?Is there any evidence of meningism or blunting of consciousness?
Are they aware of having a rash?The latter may be seen in the early stages of encephalitis.
Ask specifically about things such as unsteadiness/vertigo, ability to concentrate, dysuria, frequency, offensive vaginal discharge.Check the tympanic membrane, throat and cervical lymph glands.
Infective contacts/travelCheck the eyes for evidence of jaundice.
Has anyone else in the family/at work had a similar problem?Systems exam
Has the patient recently returned from abroad? If so where from?Listen to and percuss the chest.
Have they been in contact with anyone with a known infectious illness?Palpate the abdomen and renal angles. Ask the patient to cough – does it hurt their abdomen to do so? This may indicate a degree of peritonism.
Check a urine specimen for blood or nitrites if appropriate – it is always appropriate if no other obvious cause has been found even in the absence of urinary symptoms. This is especially true of the very young and the elderly.