fever

Question 1

fever is also called

Answer 1

pyrexia

Question 2

what are some serious signs to watch for during fever?

Answer 2

confusion
hallucination
dehydration

Question 3

____ is common under age 5

Answer 3

febrile seizures

Question 4

older adults have ___ fever response

Answer 4

blunted

Question 5

pathophysiology of fever

Answer 5

infectious agents/toxins/medication of inflammation (pyrogens) – stimulates mnocytes/macrophages/endothelial cells to release pyrogenic cytokines (IL 1, IL6, TNF, IFNs)–anterior hypothalamus– increase heat conservation and production –> fever

Question 6

must refer to ER for patients

Answer 6

infants less than 3 months
patients with a fever of unknown origin

Question 7

FUO adult definition

Answer 7

Body temperature greater than 38.3°C (101°F) for longer than 3 weeks duration that is undiagnosed after 3 days of hospital investigation, 3 outpatient visits, or 1 week of ambulatory investigation

Question 8

FUO pediatric definition

Answer 8

A temperature of 38.0°C (101°F) or higher on several occasions, for more than 3 weeks duration, and with a failure to reach a diagnosis despite at least 8 days of investigation

Question 9

diagnostic workup for FUO

Answer 9

CBC with differential
* Renal/liver function
* Electrolytes
* Urinalysis and urine culture
* Blood cultures x2 sets (peripheral) + any central lines
* Chest X-ray
* Lumbar puncture
* Other (depending on clinical assessment i.e. stool culture, sputum culture)

Question 10

treatment for fever

Answer 10

IV fluids
* Antipyretics
* Analgesics
* Antiemetics
* Broad spectrum antibiotics (after cultures are taken if bacterial etiology suspected)

Question 11

Systemic Inflammatory Response Syndrome (SIRS) Criteria (need 2 or more)

Answer 11

• Temp > 38.3°C or < 36°C
• HR> 90 bpm
• RR>20
• WBC > 12 000 (leukocytosis), WBC < 4000 (leukopenia) or a normal
  WBC with > 10% immature forms

Question 12

sepsis

Answer 12

Systemic infectious response (bacteremia) + 2 or more SIRS criteria

Question 13

severe sepsis

Answer 13

Sepsis complicated by any signs of organ dysfunction or hypoperfusion

Question 14

septic shock

Answer 14

Severe sepsis complicated by persistent hypotension refractory to early fluid therapy,
Persistent SBP < 90 mmHg

Question 15

pathophysiology of sepsis

Answer 15

infectious or non-infectious–> pro inflammatory response and cascade of inflammatory mediators
cytokines activate coagulation cascade
hypovolemia
cardiovascular depression
systemic inflammation