The presentation of fever with minimal symptoms can be perplexing. Patients will often show up in the emergency department with fever of 101°F-103°F accompanied by myalgias, headache, fatigue, and few other complaints. Histories are usually benign with no recent travel or sick contacts. When is it prudent to obtain blood work, cultures, flu swabs, or tick panels, or dismiss the fever as a viral syndrome? — LAWRENCE A. RUBIN, RPA-C, Southold, N.Y.

A thorough history and physical exam is the most important aspect of managing patients presenting with fever and flulike symptoms. Be aware of such signs and symptoms indicating more serious disease as exposure to illness or sick contacts; underlying endocrine, immune, or malignant disorders; rashes; neck stiffness; focal neurologic findings; or abnormal heart or lung sounds. Judicious use of laboratory or diagnostic interventions is warranted. There is no simple algorithm. An initial assessment including WBC and liver enzymes could be an acceptable first step. Continued monitoring and education to present if symptoms change or worsen is sensible. — Claire Babcock O’Connell, MPH, PA-C (149-2)

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