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Approach to Fever Flashcards

1
Q

What is a normal temperature?

A

98.2 + or - 0.7

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2
Q

What is the daily variation that occurs with fever?

A

Nadir at 0600, and peak at 1700

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3
Q

How much higher is rectal temp compared to oral?

A

Usually 1 degree F higher

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4
Q

What is the effect of menstruation on body temp?

A

Increases by a degree C

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5
Q

What is the definition of a fever?

A

Two consecutive elevations of 101 F, unless neutropenic (then just one)

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6
Q

What is the thermoregulatory center of the body?

A

Hypothalamus

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7
Q

What is the cooling center of the body?

A

Anterior hypothalamus

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8
Q

What is the heating center of the body?

A

Posterior hypothalamus

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9
Q

Where are our thermoreceptors?

A

Skin and muscles

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10
Q

What is the definition of hyperthermia?

A

Increased body temp above that set by the central regulation due to insufficient heat dissipation

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11
Q

What are the two main exogenous sources of pyrogens?

A

Toxins

Microorganisms

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12
Q

What are the major cytokines that mediate fever?

A

IL-1, IL-6, IFN, TNF

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13
Q

What is the definition of a fever of unknown origin (FUO)?

A

Fever greater than 38.3 for 2 or 3 weeks without identifiable etiology

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14
Q

What is a fever without localizing source?

A

Fever without ssx or a localizing source

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15
Q

What is the most common cause of fever without a localizing source?

A

Infectious etiology

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16
Q

What is the most common cause of fever without a source in 3-36 mo?

A

Occult bacteremia w/o ssx of sepsis

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17
Q

What are the predictors of occult bacteremia?

A
  • Fever

- WBC more than 15K

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18
Q

What is NOT predictive of occult bacteremia?

A

Response to antipyretics

Clinical appearance

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19
Q

What percent of kids with a fever w/o source and a white count of greater than 30k have occult bacteremia?

A

42.3%

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20
Q

True or false: vaccines can mask ssx

A

True

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21
Q

What is the Yale observational scale?

A

Assessment to quantify toxic appearance, with higher score meaning more toxic

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22
Q

What is the most common cause of osteomyelitis in sickle cell patients?

A

Salmonella

23
Q

What is the sensitivity and specificity of a WBC count greater than 15k for sepsis?

A

80% sensitive and specific

24
Q

True or false: patient with Neisseria meningitides always have leukocytosis?

A

False– may have leukopenia

25
Q

When are blood cultures particularly warranted?

A

If WBC more than 15k

26
Q

When are urine cultures necessary?

A

If there is an abnormal UA

27
Q

What are the labs that are helpful in the diagnosis of sepsis in infants?

A

CRP

Procalcitonin

28
Q

What diseases can result in aberrant CRP and procalcitonin levels?

A

Renal disease

29
Q

What are the four bacteria that should be suspected of causing sepsis?

A

S. pneumo
S. Aureus
Neisseria
Hemophilus

30
Q

What is the abx of choice for sepsis?

A

Ceftriaxone

31
Q

What is the most common cause of a fever without a source in adults? How is this different than in children?

A

Infections still most common as in adults, but non-infectious causes increase

32
Q

What are the four organ systems that should be suspected of causing bacteremia?

A

Lung
Urinary
Abdomen
Endocarditis

33
Q

What are the four categories of FUOs?

A

Nosocomial
Neutropenic
HIV-associated
Classic

34
Q

What specific patient population needed to be treated for sepsis urgently?

A

HIV associated or immunocompromised

35
Q

What is the most common nosocomial sepsis?

A

Pneumonia

UTIs

36
Q

What are the inflammatory causes of sepsis?

A

Aspiration
Phlebitis
Arthritis

37
Q

What percent of nosocomial fevers are caused by malignancy?

38
Q

What percent of fevers are caused by ischemia (MI, stroke, PE etc)?

39
Q

What percent of nosocomial fevers are caused by drugs?

40
Q

How can you diagnose fevers caused by drugs?

A

Monitor fevers spikes and if they occur with drug administration

41
Q

What percent of FUOs are: infectious?

42
Q

What percent of FUOs are: malignancy?

43
Q

What percent of FUOs are: inflammatory/autoimmune?

44
Q

What percent of FUOs are: undiagnosed?

45
Q

What is the most common infectious cause of FUO?

A

Abdominal abscesses

46
Q

What should be infectious cause of FUO should be suspected in DM pts?

A

Osteomyelitis

47
Q

What are the two most common malignancies that cause fevers?

A

Hodgkin’s disease
Non-Hodgkin’s
Leukemia

48
Q

What causes fever of malignancy?

A

Release of cytokines

49
Q

What is Still’s disease?

A

a rare systemic inflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain and a distinctive salmon-colored bumpy rash

Unknown cause

50
Q

What are the autoimmune diseases that can cause FUOs?

A

SLE
Still’s disease
Polymyalgia rheumatic

51
Q

What are the three most common autoimmune causes of FUOs?

A
  • Granulomatous hepatitis
  • Crohn’s
  • Sarcoidosis
52
Q

What is Sutton’s law?

A

First, consider the obvious

53
Q

What is the classic cause of IL-12 resistance?

A

BCG vaccine

54
Q

What is temporal arteritis?

A

Vasculitis of the branches of the external carotid artery, which may affect the ophthalmic artery

Infectious Disease (18 decks)

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