Content Objective: Fever/Common Infections

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

1. Perform a focused history and physical exam to determine presence of fever, fever pattern, and associated symptoms & signs, so as to:
   • make a determination as to whether a patient truly has/has had a fever, and whether it is acute versus chronic.
   • identify patients with serious illness.
   • demonstrate good understanding of the potential groups of cause of fever (infection, malignancy, drugs, environment (sun, heat).)
   • 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 of fever, based in the local context.


4. Propose a basic plan of management for fever that includes:
   1. simple at home measures including antipyretics.
   2. guidance for patients/caregivers on how to access care depending on evolution of illness.
5. Propose empiric therapy for the following conditions:
   • URTI (cold, pharyngitis, laryngitis, sinusitis)
   • LRTI (pneumonia, acute bronchitis)
   • Red eye/conjunctivitis
   • Acute Otitis Media
   • Influenza/COVID-19
   • Vaginal/urethral discharge
   • UTI/Complicated UTI/Pyelonephritis
   • Cellulitis

Mandatory Clinical Encounter

• URTI

Resources*

• Roth AR, Basello GM. Approach to the patient with Fever of Unknow Origin. Am Fam Physician; 2003 68(11):2223-2228.
• Evaluating Fever of Unidentifiable Source in Young Children
• Update Antibiotics: Why and Why not to 2018
• Le Saux N, Robinson JL. Management of acute otitis media in children 6 months of age and older. CPS Position Statement. Paediatric Child Health  2016; 21(1): 39-44
• Viral Rhinitis, Influenza, Sinustitis and Pharyngitis, search in RxTx
• Community-Acquired Pneumonia, search in RxTx
• Cronau, H et al. Diagnosis and Management of Red Eye in Primary Care, Am Fam Physician. 2010 Jan 15;81(2):137-144
• Dysuria: Evaulation and Differential Diagnosis in Adults
• Diagnosis and Treatment of Acute Uncomplicated Cystitis

* Where a specific resource is not listed for a particular objective, please refer to recommended general texts/websites. Resources have often been selected from the Clinical Practice Guidelines and Protocols in British Columbia and Alberta’s Towards Optimized Practice Clinical Practice Guidelines. These are often concise summaries of national guidelines.