A 45 year old male presents to your emergency department with 1 day of headache, body aches, nausea and vomiting?  On further history you learn that the patient recently returned from a trip to Africa and you suspect Yellow Fever.  Which of the following below would increase your suspicion for Yellow Fever? (scroll down for the answer) 

A) Low pulse relative to fever  

B) Leukocytosis 

C) Diffuse Urticaria 

D) Hematuria 

E) Anisocoria 

The correct answer is A) Low pulse relative to fever

Yellow Fever Pearls 

• Mosquito borne illness 
• Should be suspected in patients returning from South America and Arica 
• Nonspecific symptoms during period of infection (fever, malaise, myalgia, headache, nausea/vomiting)
• Transaminitis, leukopenia, thrombocytopenia 
• Low pulse rate relative to fever (Faget’s sign) 
• Treatment is supportive care 
• Vaccination available 

 Stapczynski, J. Stephan,, and Judith E. Tintinalli. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011.