(5.2) Comprehensive Clinical Review (Fever) [Tyler] Flashcards
Fever is a rise in body temperature in response to ______
Endogenous cytokines
Fever is controlled by the _____ area of the hypothalamus
Preoptic
What cytokines act on the thermoregulatory portion of the hypothalamus?
Endogenous Pyrogens (IL-1, TNF, interferon alpha)
What is the most common cause of fever in hospitals?
Community-acquired infection (51%)
What is the most common cause of fever of unknown origin (FUO)?
Infection (tuberculosis, intra-abdominal abscess)
Why do night sweats occur?
Exaggeration of normal circadian temperature rhythm
What are the diagnostic criteria for fever of unknown origin (FUO)?
Fever >101 F
Illness >3 weeks
No known immunocompromised state
Dx remains uncertain even after thorough hx of lab workup
When would you give antibiotics for fever of unknown origin?
If sepsis or toxicity is apparent
What demographics represent the highest risk group for fever of unknown origin?
>65 yo
Chronic disease
Usually have bacterial infection
Alarm sx for fever?
Fever >105 F
Rash
Change in mental status/level of sensorium
Dizziness/lightheadedness
Recent chemotherapy
SOA/chest pain
Alarm sx for fever:
Considerations for fever >105 F?
CNS infection
Neuroleptic Malignant Syndrome (NMS)
Heat stroke
Alarm sx for fever:
Considerations for rash?
Meningitis
Bacteremia w/ septic shock
Rickettsial disease
Bacterial endocarditis
Benign causes - viral exanthem, drug fever
Alarm sx for fever:
Considerations for change in mental status/level of sensorium?
Meningitis
Neuroleptic malignant syndrome (NMS)
Heat shock
Encephalitis
Bacterial infections with septic shock
Alarm sx for fever:
Considerations for dizziness, lightheadedness?
Bacterial infection with septic shock
Adrenal insufficiency
PE
benign - viral infection with labyrinthitis
Alarm sx for fever:
Considerations for recent chemotherapy?
Nosocomial infection with neutropenia
Alarm sx for fever:
Considerations for SOA and chest pain?
PE
Pneumonia
Empyema
Malarial infection may have what fever patterns?
Teritan (48 hours)
Quartan (72 hours)
Diurnal fever has what fever pattern?
Fever b/w 4pm and midnight
Gram - rod sepsis and CNS infections may have what fever pattern?
Sustained fever
What are the major criteria for diagnosing endocarditis?
Positive blood culture for 2 separate cultures
Transesophageal echocardiography positive
Persistently positive blood culture result
What is the most common cause of systolic heart failure?
CAD
Associated with LV dilatation
What is the most common cause of diastolic heart failure?
HTN
Associated with LVH
What diagnostic studies would you get for heart failure?
Natiuretic peptide
Echocardiography
CXR
What is the most common way of diagnosing myocarditis?
Echocardiogrpahy (most convenient)
What might you see on an EKG for myocarditis?
Sinus tachycardia
Q waves or LBBB
Ventricular ectopy - may be the only finding
What are the most common symptoms presenting in granulomatosis with polyangiitis (wegener’s)?
Upper/Lower respiratory sx
Renal insufficiency
Skin lesions
Visual disturbance
Pulmonary embolism is the 3rd leading cause of death in ______ patients
Hospitalized
What organism is responsible for the highest case-fatality rate of all rickettsial diseases?
R. Rickettsii - Rocky Mountain Spotted Fever
What is the most common vector-borne illness in the US?
Lyme disease
What is the difference between hyperthermia and fever/
Fever is due to endogenous pyrogen
Hyperthermia is due to inability of body to dissipate heat
Most cases of temperatures higher than ____ are considered to hyperthermia.
105.8 F
What malignancies are associated with fever?
Lymphoma
Leukemia
Renal cell cell carcinoma
Metastatic liver CA
Pt presents with high fever. After lab studies and examination return negative, they mention that they’ve recently been prescribed a new medication. What diagnosis is now included in your Ddx? What should you do next?
Drug fever
Remove new drug
Why might chills not be a benign sx in fever?
Chills may increase risk of bacteremia due to shaking
What are the malignancies most commonly associated with FUO?
Hodgkin’s disease
Non-Hodgkin’s lymphoma
What inflammatory Ddx must be considered in a patient with a fever?
Giant cell arteritis
Inflammatory Bowel disease
SLE
Polyarteritis nodosa
Wegener’s granulomatosis
Rheumatic fever
What heart sound may be heard with systolic HF?
S3
What heart sound may be heard with diastolic heart failure?
S4
What cardiac enzymes might be elevated in myocarditis?
Troponin I
CK-MB only elevated in 10%
What 4 sx may be indicative of a PE?
Syncope
Dyspnea
Chest pain
Hemoptysis
What characterizes stage 1 of Lyme disease?
Central erythema
Induration
Necrosis
Vesicular changes
What characterizes stage 2 of Lyme disease?
Neuro deficits
Annular skin lesions
Severe HA
Stiff neck
Migratory arthralgia
Fever/Chills
What characterizes stage 3 of Lyme disease?
Arthritis
Chronic CNS problems
Acrodermititis chronica atrophicans
