Approach to fever

Question 1

normal temperature

Answer 1

36.8 +/- 0.4 C (98.2 +/- 0.7 F)

Question 2

fever: definition

Answer 2

• core temperature of 38.0 C (100.4 F)
• two consecutive elevations of 38.3 C (101.0 F)
• neutropenic patients: single oral temperature of 38.3 C (101.0 F) in absence of obvious environmental cause or elevation of 38.0 C (100.4 F) for 1 hour

Question 3

hypothalamic increase in set point is caused by what compounds?

Answer 3

pyrogens (exogenous and endogenous)

Question 4

definition: hyperthermia

Answer 4

increased body temperature above that set by central regulation due to insufficient heat dissipation

Question 5

definition: exogenous and endogenous pyrogens

Answer 5

• exogenous: microorganisms, toxins

- endogenous: host cell derived (cytokines, immune complexes, complement)

Question 6

what are the pyrogenic cytokines?

Answer 6

IL-1B 
IL-1 
TNF 
IFNy 
IL-6

Question 7

FWS and FUO

Answer 7

• FWS - fever without localizing source (more common in children)
• FUO - fever of unknown origin

Question 8

FWS in children 3-36 months: main etiology

Answer 8

occult bacteremia

Question 9

yale observation scale interpretation

Answer 9

score 0-10: incidence of severe illness 2.7%
score 11-15: incidence of severe illness 26%
score over 16 or over: incidence of severe illness 92.3%

Question 10

in FWS in 3-36 month patients, parenteral abx are indicated under what circumstances?

Answer 10

ill-appearing
unstable vital signs
lab findings
immunization status

Question 11

what are the targets for parenteral abx in FWS patients 3-36 months old? which abx are used?

Answer 11

s. pneumo
s. aureus
neisseria
haemophilus

IM or IV ceftriaxone

Question 12

in adults, when is the use of empirical abx warranted?

Answer 12

only after meticulous history and physical in combination with lab data

Question 13

what are the categories of FUO?

Answer 13

nosocomial
neutropenic
HIV associated
classic

Question 14

diagnosis in classic FUO is due to which main causes?

Answer 14

infection (30%)
malignancy (30%)
inflammatory - autoimmune (10%)

Question 15

what are the top 3 classic FUO infectious etiologies?

Answer 15

abdominal abscesses
mycobacterial
CMV

Question 16

what are the most common malignancies manifesting as FUO?

Answer 16

hodgkins disease 
non-hodgkins lymphoma 
leukemia 
renal cell carcinoma 
hepatoma