Fever

Question 1

Diurnal changes in body temperature are dependent on

Answer 1

Sleep-wake cycle
and
How you measure temperature - oral most variable

Question 2

What is febrile neutropenia

Answer 2

greater than 38.3 orally or more than 38 for more than hour

Question 3

Fever of unknown origin

Answer 3

more than 38 on multiple readings over 3 weeks

- No cause after initial investigation

Question 4

FUO is not applicable when

Answer 4

FN, HIV, HSCT, nosocomial acquisition

or to returned travelers or children

Question 5

Normal body temp

Answer 5

between 36.5-37

Question 6

how does the hypothalamus cool body temp

Answer 6

• Inreases cutaneous blood flow
• Sweating
• Decreases GI blood flow

Question 7

how does the hypothalamus increase body temp

Answer 7

• Shivering

- Decrease Cutaneous blood flow

Question 8

Fever results in

Answer 8

An increase in the hypothalamic set point

Question 9

4 Pyogenic cytokines

Answer 9

IL-1
TNF-a
IFN
IL-6

Question 10

The release of pyogenic cytokines results in

Answer 10

PGE2 increase

Question 11

What leads to the increase in the hypothalamic set point?

Answer 11

PGE2 secretion

Question 12

What does the hypothalamus do when set point goes up

Answer 12

Wants to cool body down

• Decrease cutaneous blood flow
• Chills
• Shivering to generate heat match rise in setpoint
• Thermogenesis of brown fat

Question 13

Evolutionary advantage of fever

Answer 13

Increase survival against Gram negatives and peritonitis?

Question 14

With antipyretics you get

Answer 14

prolonged viral shedding

Question 15

Fevers are almost always…..

Answer 15

<41

Question 16

Disadvantages to having a fever are

Answer 16

symptoms
- chills and rigors 
- sweats
TACHy cardia, TACHypnea
- delirium 
- arthralgias/myalgias (due to PGE2)

Question 17

Children may develop…… from fever?

Answer 17

Febrile seizures >39

Question 18

What 2 things are NOT fever

Answer 18

Hyperthermia

Hyperpyrexia

Question 19

What is hyperthermia

Answer 19

• inability to lose heat
• UNCHANGED hypothalamic set point
• heat stroke, malignant hyperthermia, neuroleptic

Question 20

What is hyperpyrexia

Answer 20

> 41 temp

CNS Hemorrhage

Question 21

Nowadays what are some causes of FUO

Answer 21

• malignancy
• autoimmune disease
  certain infections

Question 22

How do antipyretics work?

Answer 22

Block COX - block production of prostaglandins

Question 23

What are some common antipyretics?

Answer 23

ASA salicylates

• tylenol
• NSAIDs
• CORTICOSTEROIDS - (dont use!!)

Question 24

When to use anti-pyretics?

Answer 24

• fever is prolonged/severe

- Hyperpyrexia - external cooling as well

Question 25

When should you NOT use anti-pyretics?

Answer 25

• Hyperthermia!

Question 26

When during the day is your temperature the lowest?

Answer 26

2 and 6 am - as long as that is during your sleep cycle

Question 27

What cells do the pyogenic cytokines interact with?

Answer 27

Vascular endothelium - circumventricular