fever

Question 1

Define fever:

Answer 1

systematic, nonspecific defense response to infection or tissue damage.
>38.3

Question 2

5 categories of fever:

Answer 2

1) Infection
2) collagen vascular
3) neoplasms
4) misc
5) FUO

Question 3

What fever mechanism is triggered by IL-1 and TNF?

Answer 3

endogenous

Question 4

What triggers the exogenous fever mechanism?

Answer 4

destruction (via phagocytosis) of the lipopolysaccharide structure of bacteria which releases endotoxins

Question 5

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?

Answer 5

decrease, you’re too hot!

Question 6

You’re too cold, what can your body do to elevate your temperature?

Answer 6

shiver, increase thyroid activity–>which increases BMR, vasoconstriction

Question 7

What benefit does an increase in metabolism have during fever?

Answer 7

increases tissue repair

Question 8

Healthy individuals can tolerate a fever up to _________ degrees prior to seeing any ill effects

Answer 8

105

Question 9

Extreme hyperthermia begins at _____ degrees and can cause what effects?

Answer 9

108.

1) DIC
2) metabolic derangement
3) hypoxia
4) sz/coma

Question 10

When should you treat a fever aggressively?

Answer 10

Patients with severe primary disease (heart/lungs/kidneys)

Question 11

What is you goal when recommending an antipyretic?

Answer 11

Reduce fever just enough to relieve symptoms, but not all the way to normal, so it maintains beneficial effects

Question 12

Any child with a fever under the age of ________ is at serious risk for what?

Answer 12

3 months, meningitis or other serious infection

Question 13

What is the most frequent cause of fever?

Answer 13

virus

Question 14

fever and RASH

Answer 14

r/o meningococcal septicemia

Question 15

fever and belly pain, n/v

Answer 15

r/o appendix and UTI

Question 16

fever and neck pain

Answer 16

r/o CNS infection

Question 17

fever and joint pain

Answer 17

r/o septic joint or rheumatic fever

Question 18

What is the criteria to make a dx of FUO?

Answer 18

1) illness x 3 wks
2) fever > 38.3 several times over that 3 wks
3) No dx after 1 week of study

Question 19

Big 3 of FUO:

Answer 19

1) infection
2) collagen vascular
3) neoplasm

Question 20

New murmur, elevated WBC….what are you thinking?

Answer 20

bacterial endocarditis

Question 21

Your patient c/o muscle/bone pain and has a fever. What CAN’T you miss? What is your screening tool?

Answer 21

osteomyelitis, xrays are first line

Question 22

If you see a fever and an elevated ESR, what should you start to investigate?

Answer 22

collagen vascular/autoimmune disease

Question 23

What is the one genetic disease we discussed as being causative for FUO?

Answer 23

Mediterranean fever…dx by genetic testing and FHx

Question 24

What is the most common solid tumor cancer a/w FUO?

Answer 24

renal cell carcinoma

non solid = lymphoma and leukemia

Question 25

Some drugs can cause fever. Obviously you’ll d/c those drugs. What are they?

Answer 25

beta lactams, procainamide, isoniazid, alpha-methyldopa, quinidine, and phenytoin

Question 26

What endocrine disorders might cause fever?

Answer 26

hyperthyroid, thyroiditis, adrenal insufficiency