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CPR-2 > DSA Fever > Flashcards

DSA Fever Flashcards

1
Q

What is a fever?

A
  • A rise in body temperature in response to endogenous cytokines
  • 37.4C (99.4F) to 38C (100.4F)
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2
Q

What controls the normal, narrow range of temperature? what is that range?

A
  • preoptic area of the hypothalamus

- 36.0° to 37.8°C (96.8°–100.0°F).

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3
Q

What are chills? night sweats?

A
  • subjective report of shaking/shivering due to rapid change in body temp; involuntary muscle contractions
  • nocturnal sweating due to exaggeration of normal circadian temp rhythm
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4
Q

How is a fever created?

A

EP –> hypothalamus –> fever due to release of PGE2, monoamines, cations, or cyclic AMP

*EP can be stimulated by LPS, lymphokines,

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5
Q

What are the three endogenous pyrogens?

A

IL1, TNF, interferon alpha

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6
Q

What is hyperthermia?

A
  • elevation in body temp due to loss of homeostatic mechanisms and inability to increase heat loss in response to environmental heat
  • levels to 41C (105.8F).
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7
Q

Why are fever and hyperthermia considered the same?

A

they’re not –>

  • hyperthermia is due to inability of body to dissipate heat
  • fever is due to EPs
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8
Q

Pt. presents with fever of 105.8F. What is top of your ddx?

A

hyperthermia

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9
Q

Pt. presents with fever of 101F lasting approximately one month. All cultures are negative, CXR is clear, and CBC is upper limits of normal. What should you suspect?

A

Fever of unknown origin

*Fever that last 3 weeks or longer with temperatures exceeding 38.3C (100.9F) with no clear diagnosis despite 1 week of clinical investigation

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10
Q

What is the most common cause of fever in older patients?

A

infection (bacterial)

3 common spots:

  • Respiratory tract
  • Urinary Tract
  • Skin/soft tissue
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11
Q

What malignancies are known to cause fever?

A

lymphoma, leukemia, renal cell carcinoma, primary or metastatic liver cancer

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12
Q

pt. is prescribed new medication for heart health. Returns to your clinic with high fever. CXR is negative, cultures are negative, CBC is normal. How should you treat?

A

remove new drug - may have Drug Fever

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13
Q

What is dangerous about chills?

A

the shaking increases risk of bacteremia

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14
Q

What are the most common causes of nosocomial infections?

A
  1. Bacterial
  2. Non infectious etiologies
  3. Unknown source
  4. nonbacterial
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15
Q

Pt. presents, and is dx with FUO. What malignancies should you be concerned of? What infections?

A

a. Hodgkin’s disease or non-Hodgkin’s lymphoma

b. TB and intra abdominal abscesses

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16
Q

AA F presents with fever. you notice rash on face, and self reports of arthritis are given. Most likely dx?

A

SLE

*36% of SLE pts present with fever; and 52% develop one during dx evolution

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17
Q

What three disease have fever on presentation often?

A
  • SLE, Giant cell arteritis, IBD
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18
Q

What are the alarm sx of a fever?

A
  • high fever (>105.8F)
  • rash
  • change in mentation
  • dizzy/light headed
  • recent chemo tx
  • SOB or chest pain
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19
Q

If high fever is present, consider…

A

CNS infection, NMS, heat stroke

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20
Q

If rash is present with fever, consider…

A

meningitis, bacteremia with septic shock, rickettsial disease, bacterial endocarditis

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21
Q

If mentation change is present with fever, consider…

A

meningitis, encephalitis, NMS, heat stroke, bacterial infection with septic shock

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22
Q

If dizzy/LH is present with fever, consider…

A

bacterial infection with septic shock, adrenal insufficiency, PE

23
Q

If recent chemo is present with fever, consider…

A

nosocomial infection with neutropenia

24
Q

If SOB/chest pain is present with fever, consider…

A

PE, pneumonia, empyema

25
Q

Pt. presents with fever, Janeway lesions, and Roth spots. They admit to using heroin, and had just gotten out of a rehab center in the hospital. You hear an opening snap on auscultation, and learn they suffered from an un treated strep infection as a child. What is the dx? what are the main risk factors this pt faced? How should you go about confirming your dx?

A
  1. Infective endocarditis
  2. health care contact and injection drug use are the primary risk factors. IE is associated, traditionally, with RHD
  3. blood culture

*Staph aureus if leading cause of IE

26
Q

What is the difference between HFrEF and HF with preserved EF? Main causes of each?

A

a. LV EF 40% or less - CAD–> LV dilation

b. LV EF 50% or more - HTN –> LV hypertrophy

27
Q

What specific signs are seen on PE of HF pt?

A

o Prominent jugular venous distention
o Positive hepatojugular reflux
o Laterally displaced apical impulse
o Presence of S3 gallop with systolic HF; may have S4 gallop with diastolic HF

28
Q

Pt. presents one week post URI onset, and is now experiencing chest pain, dyspnea, and tachypnea. Echo finds cardiomegaly and contractile dysfunction. Pericardial friction rub is present. MI is ruled out due to normal coronary arteries. What is your dx? What prompted that?

A

a. Myocarditis
b. HF sx, post URI, cardiomegaly, contractile dysfunction, pericardial friction rub, not an MI

*primary myocarditis is caused by either an acute viral infection or a post-viral
immune response.
*secondary is result of inflammation caused by non-viral pathogens, medications, chemicals, physical agents,
or inflammatory diseases (such as systemic lupus erythematosus).

29
Q

What may the ECG show in myocarditis?

A
  • sinus tachycardia, other arrhythmias, nonspecific repolarization changes, and intraventricular conduction abnormalities, Q waves or left bundle branch block
30
Q

What may be in the initial, and only, finding in myocarditis?

A

ventricular ectopy

31
Q

What levels are elevated in myocarditis?

A

Troponin I or T levels are elevated in about one-third of patients, but CK-MB is elevated in only 10%. Other biomarkers, such as BNP and NT-proBNP, are usually elevated.

32
Q

40 y/o WM Pt. presents complaining of recurrent nose bleeds, a cough, visual disturbances, and skin lesions. What does he have?

A

Wegener’s

*Most commonly associated signs/symptoms: Upper and lower respiratory symptoms, renal insufficiency, skin lesions, visual disturbance

33
Q

65y/o WM presents with “bruises” and itchy red bumps. He also reports bowel bleeding and muscle pains. DX?

A

Microscopic Polyangitis - MPO ANCA

  • Most commonly associated signs/symptoms: Palpable purpura, macules, vesicles, bullae, urticaria
  • from Martin’s slides: hemoptysis, hematuria, proteinuria, bowel pain or bleeding, muscle pain or weakness, palpable Purpura
34
Q

Pt. presents with track marks, fever, HTN (previous visit 1 year ago was 123/80, but now is 190/140), and myalgias. She admits to sharing needles with her bf. You confirm HBsAG-HBsAB complexes are present and dx her with Hep B. You’re done, right?

A

nah she probs has polyarteritis nodosa too

*Most commonly associated sx: fever, HTN, myalgias, abdominal pain, hematuria, CHF, GI bleeds, orchitis

35
Q

If a pt has at least one of what four sx would make you consider a PE?

A

syncope, dyspnea, chest pain, hemoptysis

*but no single sx is reliably diagnostic of PE

36
Q

A high risk PE pt presents with what? Intermediate risk? low risk?

A

a. Severe dyspnea at rest, Hemodynamic instability that may present as syncope or cardiac arrest
b/c. may be asymptomatic or minimally symptomatic

37
Q

What are the most common findings of a PE pt?

A

 Patient may appear anxious but otherwise comfortable or patient may appear to be very ill
 Hypoxemia (with cyanosis in massive or sub-massive pulmonary embolism)
 Tachypnea
 Tachycardia
 Rales
 Decreased breath sounds

38
Q

What is the dx of FUO?

A

 Fever ≥38.3°C (≥101°F) on at least two occasions
 Illness duration of ≥3 weeks
 No known immunocompromised state
 Diagnosis that remains uncertain after a thorough history-taking, physical examination, and the obligatory investigations (ex. ESR, CPR…)

*often necessary to withhold ABs if source isn’t apparent (unless pt is septic or toxic)

39
Q

Most common causes of FUO?

A

infection, noninfectious inflammatory diseases, and neoplasms

40
Q

Most common sites of infection for nosocomial infections?

A

bloodstream, lungs, urinary tract, surgical wounds

41
Q

During morning rounds, you check on your 75y/o F DM patient that has been in the hospital for months due to terminal cancer. On inspection, her catheter is secure. Her daughter, who is a nurse, is present. She reports her mother has declined her outdoor walk due to weakness. What are the risk factors for this pt developing a nosocomial infection?

A
  • age, catheter, nurse (healthcare personnel exposure), lengthy stay, only indoor air exposure, DM
others include: 
 Prior antibiotic use
 Iatrogenic
 Conditions which require a high amount of interventional procedures (e.g., shock, major trauma, acute renal failure, coma)
 Mechanical ventilation
42
Q

What causes Human Monocytotropic Ehrlichiosis (HME)?

A
  • Ehrlichia chaffeensis

- transmitted via Lone Star Tick (white tailed deer are major reservoir)

43
Q

What sx are seen in HME?

A
  • fever, HA, myalgia, malaise
  • leukopenia, thrombocytopenia, elevated aminotransferase levels are also common

*complications include: toxic shock like syndrome, respiratory distress, cardiac failure, hepatitis, meningoencephalitis, fulminant infection, hemorrhage

44
Q

What causes ROCKY MOUNTAIN SPOTTED FEVER (RMSF)?

A
  • R. rickettsii
  • tick transmission
  • the prevalence is highest in the south-central and southeastern states
45
Q

What are the sx of RMSF?

A
  • rash (distal to proximal), fever
  • may develop hypovolemia, prerenal azotemia, hypotension, noncardiogenic pulmonary edema, renal failure, hepatic injury, and cardiac involvement with dysrhythmias
  • CNS involvement (ex. encephalitis)
46
Q

What is the cause of Lyme disease?

A
  • Borrelia burgdorferi

- Ixodes tick (NE, MW), I. pacificus (W) transmission

47
Q

Pt. presents with a red macule that expands to form red outer border and central clearing. What stage of Lyme disease is this?

A

stage 1

*Central erythema, induration, necrosis, vesicular changes, or many red rings within an outer ring are also possible.

48
Q

Pt. presents with annular skin lesions, Neuro deficits, heart probs, severe HA, stiff neck, fever, chills, migratory arthralgia. What stage of Lyme disease is this?

A

stage 2

49
Q

Pt. presents with frank arthritis, chronic Neuro probs (memory, mood, sleep alterations), and Acrodermatitis chronica atrophicans. What stage of Lyme disease is this?

A

stage 3

50
Q

What is post lyme syndrome?

A

For months or years afterward, ~10% of pts have subjective pain, neurocognitive manifestations, or
fatigue symptoms

51
Q

What are common bacterial, nosocomial infections?

A

pneumonia, catheter-related sepsis, clostridium difficile diarrhea, wound infections, UTIs

52
Q

If pt presents with a fever AND recent travel, what might you suspect?

A
  1. <21 days: traveler’s diarrhea, dengue fever, yellow fever, malaria, leptospirosis, typhus, trypanosomiasis, enteric fevers
  2. > 21 days: TB, malaria, acute HIV, viral hepatitis, amebic liver disease
53
Q

Pt post hospitalization presents with fever. They were given ABs. DDX:

A

C difficile, drug fever

CPR-2 (28 decks)

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