In the following image, this type of fever graph is seen in which disease?

NORCET 2 - 2021 (shift-1)

Medical & Surgical Nursing

Easy

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

The image shows a step-ladder fever pattern, characterized by a progressive, stepwise increase in temperature over several days.
This specific pattern is a classic clinical sign of Typhoid (enteric) fever, typically observed during the first week of the illness.
In this pattern, the body temperature rises daily, with each peak being higher than the last, and the morning temperature does not return to normal.
Typhoid fever is caused by the bacterium Salmonella typhi.

Option A: Malaria causes an intermittent or relapsing fever, not a step-ladder pattern. The fever spikes periodically, such as every 48 hours (tertian fever) or 72 hours (quartan fever), with a return to normal temperature between episodes.
Option C: Dengue fever is characterized by a biphasic or 'saddleback' fever pattern. This involves an initial phase of high fever, followed by a temporary drop in temperature, and then a second febrile phase.
Option D: COVID-19 does not have a single characteristic fever pattern. The fever can be variable—remittent, intermittent, or sustained—but it is not typically the classic step-ladder pattern seen in typhoid.

Visual 1: Comparative Chart - An infographic showing side-by-side comparisons of different fever patterns: Step-ladder (Typhoid), Intermittent (Malaria), Biphasic/Saddleback (Dengue), and Remittent. This helps in visual differentiation.
Visual 2: Diagram - A flowchart illustrating the pathogenesis of Typhoid fever, from ingestion of S. typhi to the systemic infection causing the characteristic fever.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of characteristic fever patterns associated with specific infectious diseases to guide bedside assessment, documentation, and the next nursing action.
Recognizing fever patterns is a crucial nursing assessment skill that aids in the early differential diagnosis of infectious diseases, allowing for prompt and appropriate interventions.
For a patient with suspected typhoid, nurses must meticulously monitor vital signs (especially temperature and pulse to check for relative bradycardia), maintain hydration, and observe for serious complications like intestinal hemorrhage or perforation.
What if? If the fever chart showed sharp peaks every 48 hours accompanied by severe chills and sweating, the primary suspicion would shift from Typhoid to Malaria (specifically, tertian malaria caused by P. vivax or P. ovale).

How to Approach the Question

First, analyze the image provided. Identify the key feature, which is the graph's shape and the explicit label 'Step Ladder fever'.
Understand what a step-ladder fever pattern represents: a gradual, daily rise in temperature where the baseline also rises.
Review the given options: Malaria, Typhoid, Dengue, and COVID.
Recall or deduce the characteristic fever pattern for each disease.
Match the 'step-ladder' pattern from the image to the correct disease. Typhoid fever is classically associated with this pattern.
Eliminate the other options by confirming their different fever patterns (e.g., intermittent for Malaria, biphasic for Dengue).

Concept Tested & Keywords

Concept Tested: Identification of characteristic fever patterns associated with specific infectious diseases.
Stem keywords: fever graph, disease, Step Ladder fever
Lead-in keywords: which disease
Clinical cues: The image explicitly labels the graph as 'Step Ladder fever', which is the primary clue.

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