(5.2) Comprehensive Clinical Review (Fever) [Tyler]

Question 1

Fever is a rise in body temperature in response to ______

Answer 1

Endogenous cytokines

Question 2

Fever is controlled by the _____ area of the hypothalamus

Answer 2

Preoptic

Question 3

What cytokines act on the thermoregulatory portion of the hypothalamus?

Answer 3

Endogenous Pyrogens (IL-1, TNF, interferon alpha)

Question 4

What is the most common cause of fever in hospitals?

Answer 4

Community-acquired infection (51%)

Question 5

What is the most common cause of fever of unknown origin (FUO)?

Answer 5

Infection (tuberculosis, intra-abdominal abscess)

Question 6

Why do night sweats occur?

Answer 6

Exaggeration of normal circadian temperature rhythm

Question 7

What are the diagnostic criteria for fever of unknown origin (FUO)?

Answer 7

Fever >101 F

Illness >3 weeks

No known immunocompromised state

Dx remains uncertain even after thorough hx of lab workup

Question 8

When would you give antibiotics for fever of unknown origin?

Answer 8

If sepsis or toxicity is apparent

Question 9

What demographics represent the highest risk group for fever of unknown origin?

Answer 9

>65 yo

Chronic disease

Usually have bacterial infection

Question 10

Alarm sx for fever?

Answer 10

Fever >105 F

Rash

Change in mental status/level of sensorium

Dizziness/lightheadedness

Recent chemotherapy

SOA/chest pain

Question 11

Alarm sx for fever:

Considerations for fever >105 F?

Answer 11

CNS infection

Neuroleptic Malignant Syndrome (NMS)

Heat stroke

Question 12

Alarm sx for fever:

Considerations for rash?

Answer 12

Meningitis

Bacteremia w/ septic shock

Rickettsial disease

Bacterial endocarditis

Benign causes - viral exanthem, drug fever

Question 13

Alarm sx for fever:

Considerations for change in mental status/level of sensorium?

Answer 13

Meningitis

Neuroleptic malignant syndrome (NMS)

Heat shock

Encephalitis

Bacterial infections with septic shock

Question 14

Alarm sx for fever:

Considerations for dizziness, lightheadedness?

Answer 14

Bacterial infection with septic shock

Adrenal insufficiency

PE

benign - viral infection with labyrinthitis

Question 15

Alarm sx for fever:

Considerations for recent chemotherapy?

Answer 15

Nosocomial infection with neutropenia

Question 16

Alarm sx for fever:

Considerations for SOA and chest pain?

Answer 16

PE

Pneumonia

Empyema

Question 17

Malarial infection may have what fever patterns?

Answer 17

Teritan (48 hours)

Quartan (72 hours)

Question 18

Diurnal fever has what fever pattern?

Answer 18

Fever b/w 4pm and midnight

Question 19

Gram - rod sepsis and CNS infections may have what fever pattern?

Answer 19

Sustained fever

Question 20

What are the major criteria for diagnosing endocarditis?

Answer 20

Positive blood culture for 2 separate cultures

Transesophageal echocardiography positive

Persistently positive blood culture result

Question 21

What is the most common cause of systolic heart failure?

Answer 21

CAD

Associated with LV dilatation

Question 22

What is the most common cause of diastolic heart failure?

Answer 22

HTN

Associated with LVH

Question 23

What diagnostic studies would you get for heart failure?

Answer 23

Natiuretic peptide

Echocardiography

CXR

Question 24

What is the most common way of diagnosing myocarditis?

Answer 24

Echocardiogrpahy (most convenient)

Question 25

What might you see on an EKG for myocarditis?

Answer 25

Sinus tachycardia Q waves or LBBB **Ventricular ectopy - may be the only finding**

Question 26

What are the most common symptoms presenting in granulomatosis with polyangiitis (wegener's)?

Answer 26

Upper/Lower respiratory sx Renal insufficiency Skin lesions Visual disturbance

Question 27

Pulmonary embolism is the 3rd leading cause of death in ______ patients

Answer 27

Hospitalized

Question 28

What organism is responsible for the highest case-fatality rate of all rickettsial diseases?

Answer 28

R. Rickettsii - *Rocky Mountain Spotted Fever*

Question 29

What is the most common vector-borne illness in the US?

Answer 29

Lyme disease

Question 30

What is the difference between hyperthermia and fever/

Answer 30

Fever is due to endogenous pyrogen Hyperthermia is due to inability of body to dissipate heat

Question 31

Most cases of temperatures higher than ____ are considered to hyperthermia.

Answer 31

105.8 F

Question 32

What malignancies are associated with fever?

Answer 32

**Lymphoma** **Leukemia** **Renal cell cell carcinoma** Metastatic liver CA

Question 33

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?

Answer 33

Drug fever Remove new drug

Question 34

Why might chills not be a benign sx in fever?

Answer 34

Chills may increase risk of bacteremia due to shaking

Question 35

What are the malignancies most commonly associated with FUO?

Answer 35

Hodgkin's disease Non-Hodgkin's lymphoma

Question 36

What inflammatory Ddx must be considered in a patient with a fever?

Answer 36

**Giant cell arteritis** **Inflammatory Bowel disease** **SLE** Polyarteritis nodosa Wegener's granulomatosis Rheumatic fever

Question 37

What heart sound may be heard with systolic HF?

Answer 37

S3

Question 38

What heart sound may be heard with diastolic heart failure?

Answer 38

S4

Question 39

What cardiac enzymes might be elevated in myocarditis?

Answer 39

Troponin I CK-MB only elevated in 10%

Question 40

What 4 sx may be indicative of a PE?

Answer 40

Syncope Dyspnea Chest pain Hemoptysis

Question 41

What characterizes stage 1 of Lyme disease?

Answer 41

**Central erythema** Induration Necrosis Vesicular changes

Question 42

What characterizes stage 2 of Lyme disease?

Answer 42

Neuro deficits Annular skin lesions Severe HA Stiff neck Migratory arthralgia Fever/Chills

Question 43

What characterizes stage 3 of Lyme disease?

Answer 43

Arthritis Chronic CNS problems Acrodermititis chronica atrophicans