fever Flashcards
Define fever:
systematic, nonspecific defense response to infection or tissue damage.
>38.3
5 categories of fever:
1) Infection
2) collagen vascular
3) neoplasms
4) misc
5) FUO
What fever mechanism is triggered by IL-1 and TNF?
endogenous
What triggers the exogenous fever mechanism?
destruction (via phagocytosis) of the lipopolysaccharide structure of bacteria which releases endotoxins
You are sweating and lethargic. Your basal metabolic rate is dropping and you’re experiencing vasodilation. Is your body trying to increase or decrease your temperature?
decrease, you’re too hot!
You’re too cold, what can your body do to elevate your temperature?
shiver, increase thyroid activity–>which increases BMR, vasoconstriction
What benefit does an increase in metabolism have during fever?
increases tissue repair
Healthy individuals can tolerate a fever up to _________ degrees prior to seeing any ill effects
105
Extreme hyperthermia begins at _____ degrees and can cause what effects?
108.
1) DIC
2) metabolic derangement
3) hypoxia
4) sz/coma
When should you treat a fever aggressively?
Patients with severe primary disease (heart/lungs/kidneys)
What is you goal when recommending an antipyretic?
Reduce fever just enough to relieve symptoms, but not all the way to normal, so it maintains beneficial effects
Any child with a fever under the age of ________ is at serious risk for what?
3 months, meningitis or other serious infection
What is the most frequent cause of fever?
virus
fever and RASH
r/o meningococcal septicemia
fever and belly pain, n/v
r/o appendix and UTI
fever and neck pain
r/o CNS infection
fever and joint pain
r/o septic joint or rheumatic fever
What is the criteria to make a dx of FUO?
1) illness x 3 wks
2) fever > 38.3 several times over that 3 wks
3) No dx after 1 week of study
Big 3 of FUO:
1) infection
2) collagen vascular
3) neoplasm
New murmur, elevated WBC….what are you thinking?
bacterial endocarditis
Your patient c/o muscle/bone pain and has a fever. What CAN’T you miss? What is your screening tool?
osteomyelitis, xrays are first line
If you see a fever and an elevated ESR, what should you start to investigate?
collagen vascular/autoimmune disease
What is the one genetic disease we discussed as being causative for FUO?
Mediterranean fever…dx by genetic testing and FHx
What is the most common solid tumor cancer a/w FUO?
renal cell carcinoma
non solid = lymphoma and leukemia
Some drugs can cause fever. Obviously you’ll d/c those drugs. What are they?
beta lactams, procainamide, isoniazid, alpha-methyldopa, quinidine, and phenytoin
What endocrine disorders might cause fever?
hyperthyroid, thyroiditis, adrenal insufficiency
