Clinical Scenarios

Clinical Scenario

Fever and Common Infections


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

Clinical Cards



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

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

Objectives covered: 2 (partial), 4ab
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.

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

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

Objectives covered: 5a
Towards Optimized Practice (TOP). Diagnosis and Treatment of AOM in Children. 2008; Available at: 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
Wang A, Nizran P, Malone MA, Riley T. Urinary tract infections. Prim Care 2013 Sep;40(3):687-706.

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

Objectives covered: 5c
Bailey E, Kroshinsky D. Cellulitis: diagnosis and management. Dermatol Ther 2011 Mar-Apr;24(2):229-239.

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