A patient in the second week of a febrile illness presents with a fever that gradually increases each day, reaching a high plateau. This characteristic fever pattern in typhoid fever is known as:

1. A

   Intermittent fever

2. B

   Step-ladder pyrexia

3. C

   Remittent fever

4. D

   Pel-Ebstein fever

Appeared in: AIIMS Delhi NO- 2019

Explanation

• Step-ladder pyrexia is the classic fever pattern seen in the initial phase of typhoid (enteric) fever.
• It is characterized by a gradual, stepwise increase in body temperature each day, typically over the first week.
• The fever eventually reaches a high, sustained plateau, often around 39°C to 40°C (103°F to 104°F).
• This pattern reflects the systemic spread of the Salmonella Typhi bacteria from the intestines into the bloodstream.

Why Other Options Were Wrong

• Option A: Intermittent fever is incorrect because the temperature returns to a normal baseline at least once every 24 hours. The question describes a fever that reaches and maintains a high plateau.
• Option C: Remittent fever is incorrect because, while the temperature fluctuates, it never returns to normal. The key feature in the question is the specific gradual daily rise, which defines the step-ladder pattern, not just fluctuation above normal.
• Option D: Pel-Ebstein fever is incorrect as it describes a unique cyclical pattern where periods of fever lasting for days or weeks alternate with afebrile periods of similar length.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Characteristic fever patterns in clinical diagnosis to guide bedside assessment, documentation, and the next nursing action.
• Recognizing fever patterns is a vital nursing assessment skill that helps in the differential diagnosis of febrile illnesses, guiding further investigations and timely treatment.
• A patient with suspected typhoid presenting with a step-ladder fever requires close monitoring for complications like intestinal perforation or hemorrhage, and maintenance of fluid and electrolyte balance.
• What if? If the patient's fever spiked to 40°C every 48 hours but was normal in between, the pattern would be intermittent (specifically, tertian fever), making malaria a much more likely diagnosis than typhoid.

How to Approach the Question

• First, identify the key clinical information in the question stem: the diagnosis ('typhoid fever') and the specific description of the fever ('gradually increases each day, reaching a high plateau').
• The question asks you to name this specific pattern. This is a factual recall question based on clinical knowledge.
• Review the definitions of the fever patterns provided in the options.
• Compare the description in the stem with the definitions.
• The term 'step-ladder' directly corresponds to a fever that rises in gradual steps.
• Eliminate the other options based on their definitions: 'intermittent' returns to normal, 'remittent' fluctuates above normal, and 'Pel-Ebstein' is cyclical over weeks.

Concept Tested & Keywords

• Concept Tested: Characteristic fever patterns in clinical diagnosis
• Stem keywords: typhoid fever, febrile illness, fever, gradually increases, high plateau
• Lead-in keywords: characteristic fever pattern, known as
• Clinical cues: The description 'gradually increases each day, reaching a high plateau' is the defining clue for a step-ladder pattern.

Question ID

Q-qRdbBJ0THRSK_uIOlpts

Copy ID

Reference Book

E6 Nutrition Kumud Khanna 2e p. 196-198

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1642-1644

E6 Nursing Fundamentals Taylor p. 118-120