EXAM #1: APPROACH TO FEVER

Question 1

What is the definition of a fever?

Answer 1

Core temperature of 38.0 degrees C or 100.4 F

Question 2

In the neutropenic patient, what is a fever?

Answer 2

Core temperature of 38.0 degrees C or 100.4 F for an HOUR

or

SINGLE oral temperature of 38.3 C/ 101.0 F

Question 3

What causes a fever?

Answer 3

• Altered hypothalamic set point to a higher temperature

- Endogenous/ exogenous PYROGENS lead to the change in set point

Question 4

What is central fever?

Answer 4

Lesion of the hypothalamus causing fever

Question 5

What are the major exogenous pyrogens?

Answer 5

1) Toxins

2) Microorganisms

Question 6

What are the major endogenous pyrogenic cytokines (4)?

Answer 6

IL-1B
IL-1a
TNFa
IL-6

Question 7

What is a fever without a localizing source? What patient population is this more common in?

Answer 7

Patient with fever but no without focal signs of infection e.g.

• Self-limited viral
• Self-limited or occult bacterial

Question 8

What is the definition of fever of unknown origin?

Answer 8

Fever greater than 38.3 C that:

• Lasts 2-3 weeks
• Occurs on multiple visits
• Unable to id. despite work-up

Question 9

What would lead to suspect occult bacteremia in a patient with fever without source?

Answer 9

Age 3-36 months

1) Fever grater than 39 C
2) WBC greater than 15K

*Note that response to antipyretics and clinical appearance are NOT good predictors of the absence of occult bacteremia

Question 10

What is the utility of the Yale Observational scale?

Answer 10

Quantification of “toxic appearance”

*The higher the score, the more likely the presence of occult bacteremia

Question 11

When are parenteral antibiotics indicated for a 3-36 months with fever without source?

Answer 11

1) Ill appearing
2) Unstable
3) Abnormal lab findings
4) Un-immunized

Question 12

What abx should be given for kids between 3-36 months with fever without source?

Answer 12

Ceftriaxone

Question 13

What bacteria are you targeting with Ceftriaxone in a child with fever without source?

Answer 13

S. pneumoniae
S. aureus
N. meningititis
H. influenza

Question 14

How does fever without source differ in adults compared to kids?

Answer 14

More likely to be a noninfectious source

Question 15

What are the four major types of fever with an unknown origin?

Answer 15

1) Nosocomial
2) Neurtropenic
3) HIV-associated
4) Classic

Question 16

What is the most common cause of nosocomial fever?

Answer 16

Nosocomial infection

Question 17

What are the most common causes of classic fever of unknown origin?

Answer 17

Infection and malignancy are tied (30% each)

Question 18

In infectious causes of fever of unknown origin, what is the most common cause of fever?

Answer 18

Abdominal abscess (esp. if the patient had sustained trauma)

Question 19

What is the most common malignancy to cause FUO?

Answer 19

Lymphoma (Hodgkin’s and Non-Hodgkin’s)

Question 20

What is an Pel-Ebstein fever?

Answer 20

Patient experiences fevers which cyclically increase then decrease over an average period of one or two weeks

*Associated with Lymphoma