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DDx > Fever > Flashcards

Fever Flashcards

1
Q

Systematic, non-specific defensive response secondary to infection or tissue damage indicated by high body temperature (38.3C or greater)

A

Fever

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2
Q

What is responsible for Body Temp Regulation?

A

Hypothalamus
Specifically the Anterior Hypothalamus, which receives information from Central and Peripheral Thermoceptors in the body.

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3
Q

What is the Normal Temperatures for:

  1. Oral
  2. Rectal
  3. Axillary
  4. Tympanic
A
  1. Oral = 35.8 - 37.3C (96.4 - 99.1F)
  2. Rectal = 36.1 - 37.4C (97.6 - 99.3F)
  3. Axillary = 36.5 - 37.4C (97.5 - 99.3F)
  4. Tympanic = 35.8 - 37.5C (96.4 - 99.5F)
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4
Q

T/F: Fevers are usually highest in the morning.

A

False!
Fevers are usually higher in the evening, so you want to monitor temperature throughout the day.

Afebrile temps in the morning doesn’t mean the pt is afebrile.

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5
Q

Main causes of Fever

A
  • Infections (20-40%)
  • Neoplasms (7-20%)
  • Collagen Vascular Dz (15-25%)
  • Miscellaneous Dz
  • Fever of Unknown Origin (FUO)
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6
Q

T/F: Literature suggests that between 5 and 15% of FUO cases defy the diagnosis.

A

True

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7
Q

Endogenous Mechanism of Fever:

A
  • Interleukin-1 (IL-1) released by the macrophage

- Tumor Necrosis Factor released from cells (macrophages, mast cells, or endothelial cells)

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8
Q

Exogenous Mechanism of Fever:

A
  • Phagocytosis destruction of bacteria and release of the endotoxin LPS (Lipopolysaccharide)
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9
Q

Beneficial Effects of Fever

A
  • Helps set up specific defense (production of T-Cells)
  • Speeds up metabolism for tissue repair
  • Increases the antiviral effect of interferons
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10
Q

T/F: Healthy individuals can tolerate temperatures up to 110F (43.33C) without ill effects.

A

False, 105F (40.5C)

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11
Q

Consequences of Fever

A
  1. Children can get convulsions
  2. Elderly can get Myocardial Failure, Ischemia, or Shock
  3. Immunocompromise
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12
Q

At what temperature is someone dx with EXTREME hyperthermia?

A

108F (42.22C)

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13
Q

What can Extreme Hyperthermia cause?

A
  • Endothelial Vascular Damage
  • Disseminated Intravascular Coagulation (DIC)
  • Metabolic Derangements
  • Hypoxia
  • Seizures/Coma
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14
Q

Things to think about when someone presents with a Fever:

A
  • Host Factors (Vulnerable? Toxic?)
  • What could cause this?
  • Symptoms?
  • Pattern of Fever
  • Drug use?
  • Hypersensitive?
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15
Q

Sign/Symptoms

A
  • Sometimes asymptomatic
  • Warmth/Flushing
  • Malaise/Myalgia
  • Fatigue
  • Chill/Rigor
  • Stupor/Lethargy
  • Convulsions
  • Tachycardia
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16
Q

When should you treat a fever immediately?

A
  • Children because of their tendency for febrile convulsions

- Patient has a serious primary dz like heart, lung, or kidney dz

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17
Q

T/F: When treating a fever, the goal of therapy is to reduce body temperature back to “normothermia.”

A

False! That does not need to be the goal!

Goal: Reduced to the extent that subjective symptoms improve but the beneficial effects remain.

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18
Q

If patient is hyperpyrexic or hyperthermic, what would your treatment be?

A
  • Physical Cooling

- Salicylates or Acetominophen

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19
Q

In practice, once you have treated a patient for fever, what are you wanting to see to fulfill the goal of therapy?

A

Temp decrease by 1-1.5C around 1-2 hours after drug administration

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20
Q

Fever without any clear focal symptoms or focal findings could indicate what?

A

Septicemia of pneumococcal or other etiology.

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21
Q

What should we do if an baby less than 3 months old presents with a fever?

A
  • Fever can cause serious fulminant dz, so don’t leave this alone
  • Observe the child’s neurological symptoms and alertness (Think Meningitis)
  • Hospital-level investigation is usually necessary!!! (But if treating outpt, make sure the parents can contact the doctor immediately in case of emergency)
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22
Q

What is the most common cause of fever and how would this present?

A

Viral

Presentation:

  • Runny Nose
  • Sore Throat
  • Cough
  • Hoarseness
  • Myalgia

Sometimes:

  • Diarrhea
  • Nausea
  • Vomiting
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23
Q

Presentation of Fever of Bacterial Origin in the CNS:

A
  • Headache
  • Neck Stiffness
  • Confusion
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24
Q

Presentation of Fever of Bacterial Origin in the LRI:

A
  • Coughing
  • Difficulty Breathing
  • Thick Mucus Production
  • Chest Pain (sometimes)
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25
Q

Presentation of Fever of Bacterial Origin in the URI:

A
  • Runny Nose
  • Headache
  • Cough
  • Sore Throat
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26
Q

Presentation of Fever of Bacterial Origin in the GU:

A
  • Burning
  • Frequency
  • Suprapubic Pain
  • Back Pain
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27
Q

Presentation of Fever of Bacterial Origin in the GI:

A
  • Diarrhea
  • Nausea
  • Vomiting
  • Hematochezia
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28
Q

Presentation of Fever of Bacterial Origin in the Skin:

A
  • Redness
  • Swelling
  • Warmth
  • Pus
  • Pain occurs at site of infection
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29
Q

QUICK, What should you think!

Fever with Rash

A

Meningococcal Septicemia

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30
Q

QUICK, What should you think!

Fever with Stomach Pain and Vomiting

A
  • Appendicitis

- UTI

31
Q

QUICK, What should you think!

Fever with Neck Pain

A

CNS Infection

32
Q

QUICK, What should you think!

Fever with Joint Pain

A
  • Purulent Joint Infection
  • Rheumatic Fever
  • Gonorrhea in young, sexually active individuals
33
Q

How do you define a FUO (Fever of Unknown Origin)

A
  • Illness of more than 3 week duration
  • Fever higher than 38.3C (100.94F) on several occasions
  • Dx uncertain after 1 week of study in the hospital
34
Q

What are the “Big Three” of FUO?

A
  1. Infections (40%)
  2. Neoplasms (15%)
  3. Collagen Vascular Dz (20%)
35
Q

Possible causes of a bacterial abscess:

A
  • Hx of Surgery
  • Hx of Trauma
  • Hx of Endoscopy
  • Hx of Gynecological Procedure
  • Hx of Diverticulosis
36
Q

Common locations of bacterial abscesses:

A
  • Subphrenic Space
  • Liver
  • RLQ
  • LLQ
  • Retroperitoneal Space
  • Female Pelvis (tubo-ovarian abscess in PID)
37
Q

Cause of Fever that is usually due to an atypical mycobacteria in the kidneys or mesenteric lymph nodes with disseminated visceral infections. A CXR may be normal.

A

Bacterial TB

*PPD tests could be negative too because positive may not happen until 4-6 weeks after infection

38
Q

Features of Bacterial Endocarditis (aside from fever :P)

A
  • New Murmur
  • Leukocytosis
  • Embolic Events
  • Blood Cultures (3 sets from 2 different sites)
39
Q

What is the most common reason for negative blood cultures in bacterial endocarditis cases?

(5-10% of endocarditis cases have this result)

A

Prior Antibiotic Therapy

40
Q

Cause of fever assc with pain in URQ or back, nausea, vomiting, jaundice, and/or palpable gallbladder.

A

Bacterial Hepatobiliary Infections

  • Cholangitis
  • Cholecystitis
  • Gallbladder Empyema
41
Q

Labs for a Bacterial Hepatobiliary Infection would show?

A
  • Elevated LFTs
42
Q

What does Bacterial Osteomyelitis cause?

A

Localized Pain or Discomfort

43
Q

T/F: The most common reason for misdiagnosis of osteomyelitis is the failure to consider the dz in a patient who is febrile with MSK symptoms.

A

True

44
Q

Best Imaging Technique for Osteomyelitis Investigation?

A

MRI

45
Q

This cause of fever can manifest as FUO and if systemic can be caused by the onset of juvenile rheumatoid arthritis. Labs would show leukocytosis, elevated ESR, anemia, abnormal LFTs.

A

Collagen Vascular and Autoimmune Dzs

  • Polyarteritis Nodusa
  • Rheumatoid Arthritis
  • Mixed CT Dz
  • Granulomatous Dz
  • Inherited Dz
46
Q

Presentation of the following Granulomatous Dz:

Sarcoidosis

A
  • Multiorgan Involvement
  • Rarely had fever and malaise without lymph node or pulmonary involvement
  • Erythemia Nodosum occ. present
47
Q

Presentation of the following Granulomatous Dz:

Crohn’s Dz

A
  • Diarrhea

- Other Abdominal Symptoms are usually absent (esp in young adults)

48
Q

Presentation of the following Granulomatous Dz:

Granulomatous Hepatitis

A
  • Fever
  • Hepatomegaly
  • Asthenia
  • Sometimes Arthralgias
  • Sometimes Myalgias
49
Q

Labs for Granulomatous Dz:

A
  • Elevated Alkaline Phosphate Level (most consistently seen)

***Elevated serum ACE in Sarcodosis

50
Q

Presentation of the following Inherited Dz:

Mediterranean Descent Fever

A

Recurrent febrile episodes at varying intervals assc with pleural, abdominal, or joint pain due to polyserositis.

51
Q

How do you dx Mediterranean Descent Fever?

A
  • Family History

- Dx: Genetic Testing

52
Q

What neoplasms can cause Fever?

A
  • Lymphomas
  • Leukemias
  • Solid Tumors (commonly renal cell carcinoma)
  • Malignant Histiocytosis
53
Q

This is a rare rapidly progressive malignant dz that manifests as high fevers, weight loss, enlarged lymph nodes, and hepatosplenomegaly.

A

Malignant Histiocytosis

54
Q

What drugs can cause fever?

A
  • Beta-lactam abx
  • Procainamide
  • Isoniazide
  • Alpha-methyldopa
  • Quinidine
  • Phenytoin
55
Q

What do you do if you think a drug has caused the fever?

A
  • Discontinue the suspected drug
  • Within 72 hours, defervescence should occur.

If not, it is probably not a drug related cause.

56
Q

Endocrine Causes of Fever

A
  • Hyperthyroidism
  • Subacute Thyroiditis
  • Adrenal Insufficiency
57
Q

Presentation of an Endocrine Cause of Fever

A
  • Tender Thyroid
  • Exopthalomos
  • Tachycardia
  • Frequent Bowel Movements
  • Increased Sweating
  • Heat Intolerance

Labs: TSH! and CBC

58
Q

Situational Fevers can be caused by?

A
  • Travel
  • Animal
  • Occupational
  • Viral Contraction
59
Q

When a pt reports recently traveling to a tropical place and comes back with a fever, what are we thinking is the cause?

A
  • Malaria
  • Rickettsial
  • Dengue Fever
  • Schistomsomiasis
60
Q

When a pt reports recently traveling to a cosmopolitan place and comes back with a fever, what are we thinking is the cause?

A
  • Giardia
  • Lyme Dz
  • Rocky Mountain Spotted Fever
  • Amebic Dysentery
61
Q

When a pt reports having a cat and gets a fever, what are we thinking is the cause?

A
  • Pasteurella multocida

- Tocoplasmosis

62
Q

When a pt reports having a turtle and gets a fever, what are we thinking is the cause?

A

Salmonellosis

63
Q

When a pt reports contact with an animal and gets a fever, what are we thinking is the cause?

A

RABIES

64
Q

When a pt reports working in a slaughterhouse and gets a fever, what are we thinking is the cause?

A

Let’s blame the slaughterhouse.

65
Q

When a pt reports working in leather production and gets a fever, what are we thinking is the cause?

A

ANTHRAX IN THIS BIHHH

66
Q

Viral causes of Fever?

A
  • HIV
  • Hep A
  • Hep B
  • Hep C
67
Q

Indications for types of Physical Exam if pt has an acute/symptomatic fever?

A

Focused Exam

68
Q

Indications for types of Physical Exam if pt has a persistant fever?

A

Complete Exam

69
Q

Indications for types of Physical Exam if pt is hospitalized for fever?

A

Serial Exams

70
Q

Screen Labs for Evaluating a Fever

A
  • CBC
  • UA
  • Cultures
  • Serum Chemistry

Other tests driven by DDx:

  • Serology
  • ANA
  • ESR
71
Q

When would you use invasive testing in evaluation of a fever?

A

When all else fails

72
Q

The normal ranges for a lab value encompass ___% of observations including 2 SD.

A

95.4%

73
Q

Given the high inclusion rate in the normal range of a lab value, what should we think if a value is abnormal?

A

Disease Oriented!

DDx (9 decks)

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