Fever

Question 1

Definition

Answer 1

> 37.8 or 38 in kids

Question 2

Hyperthermia

Answer 2

• > 41 degrees
• Mostly non infectious

Question 3

Fever Pathogenesis

Answer 3

• Macrophage & leukocytes
• Interferons
• Prostaglandin E2

Question 4

Lab test of bacterial fever

Answer 4

• CBC: Leukocytosis (WBC>15k, PMN>1k, left shift, Band>500) or Leukopenia (WBC<1k, PMN<200)

Question 5

Hypothermia

Answer 5

• <35 degrees
• Infants: Sepsis, frostbite, antipyretics

Question 6

Fever patterns

Answer 6

1- Circadian (less morning, more evening)
2- Constant (<0.5° change)
3- Biphasic
4- تخفیف یابنده ( >0.5° تغییر)
5- Periodical (even gets normal)
6- Sepsis
7- 3-1 (m. falciparum)

Question 7

Fever treatment

Answer 7

• <39° no treatment only >41°
• No aspirin under 12y
• Acetaminophen/Ibuprofen q4-6h
• Acetaminophen 10-15mg/kg/dose (2-3 drop/kg)
• Ibuprofen 4-10mg/kg/dose (Max= 40mg/kg/day)

Question 8

Fever types

Answer 8

• With localizing signs
• FWLS (<3w)
• FUO (>3w, 1w in hospital)

Question 9

FWLS <1m old approach

Answer 9

• Less clothes
• if still >38°:
  1- Hospitalization
  2- Sepsis work-up
  3- IV Ab

Question 10

FWLS 1-3m approach

Answer 10

• Mostly viral, stimes bacterial
• If ill and toxic: fever workup
• Viral: Negative culture, 5k<WBC<15k

Question 11

Low danger signs (1-3m)

Answer 11

• 5k< WBC <15k
• Band < 15k
• U/A WBC < 10
• Stool WBC < 5

Question 12

FWLS 3-36m approach

Answer 12

• Mostly viral
• > 39° Probably Bacteremia

Question 13

Hospitalization Indications

Answer 13

• Immune deficiency
• Toxic & ill
• > 24h in Pneumococcus bacteremia
• > 24-48h in Salmonella & flu bacteremia
• > 41.1°
• With Petechiae (most common meningitis)
• FUO

Question 14

FUO Causes

Answer 14

1- Malignancy, infection, inflammation
2- After medical care procedures
3- Immune deficiency
4- HIV