OSCE : DHF History Taking

Particulars of the Patient
Name, age, residence etc as usual. Age is important for disease occurance..
Residence is important in this case because of possible outbreak. Anyone with similar illness in the neighborhood should be enquired

Chief complaints
Fever and flulike symptoms
Muscle and bone aches
red spots
vomitting, coffee-ground vomiting, black stools
abdominal pain
headache and periorbital pain
rash

Symptom Analysis

Fever
-onset- acute, ask the exact day the fever first appeared because it is useful for management.
The disease is worst in day 3 to 6. If the continuous monitoring including haematocrit traces good, patient can be discharged at day 7.
nature-continuous,
any associations-flulike symptoms +, headache, periobital pain, etc

Muscle and Bone Aches

Bleeding manifestations
-(spots appear on the body, leading questions are avoided if possible.)
-(do you notice anything appears on your body? is appropriate)
-if the child reponse is a lot of spots appears, you should specify what kind of spots are there -by asking more questions on them. --day of appearance, type of spots
-petechiae?, Pupura?, Echymosis?, Rash?
-Epistasis? Is there any blood coming out from your body, example nasal bleeding?
-Do you vomit? What color is the vomitus?
- Are they coffee ground colored?
-If the response is yes, you have to prove that it is not due to having coffee before vomiting?
You should specify that by asking whether he took coffee or not before vomiting.
-Malena ? What is the color of your poo-poo? (Is it black? is a leading question that may give false positives and not encouraged in children because they may easily nod their head.)
The malena stool is tarry black. Should be distinguished from brown color asking in details.

Abdominal pain
onset, usually 3 to 7 days after onset of fever, vague discomfort, dull in nature, tense right hypochondrium.

Urine color
May be pink to red in severe disease. If it presents, urinary becomes an issue to go details.
Bleeding at the end of voiding or before the start is likely from urithera , prostate and bladder neck.
Mixure of blood with urine with red, pink or strawberry color is likely from the upper urinary tract . Other urinary symptoms needs to be excluded.

Associated symptoms and complications needs to be asked

Conversions,
Sweating and faint, common in frequent vomiting
Paler with rashes
Lethergy,etc

Recovery Rash

It is typical confluent rash with whorls of pales and reds usually in the leg appearing at the recovery phase usually from Day 6 to Day 10.
It indicates that the disease is at the recovery phase.
It is retrospectively diagnotic of Dengue Fever.

The rash should be asked about if the child is at day 6 or later, however children may not notice though care giver may find them while tepid sponging.

Interview

After History taking, the examinor may interview you.

About epidermiology, natural history of disease, life cycle of Aedes,etc
About investigations and observation
About treatment, including fluid caculations and DSS emergency management
About prevention
About recovery rash and its clinical importance

The END. GOOD LUCK