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Correlative and Differential Dx > Fever > Flashcards

Fever Flashcards

1
Q

normal body temperature

A
  1. 8 - 37 C

96. 5 - 99 F

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2
Q

fever temperature

A

40 C

104.0 F

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3
Q

clinical importance of body temp

A

1) determine severity of illness in adults
2) course & duration of illness
3) effect of therapy on illness

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4
Q

2 exceptions in temp determining severity of illness

A

1) febrile response of kids is greater > adults

2) geriatric & neonatal responses are less marked or even absent

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5
Q

rectal temp

A

better estimate of core temp

  1. 0 F
  2. 5 C higher than oral
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6
Q

normal diurnal variation

A

96.5 F in morning
99.3 F in afternoon
~ 1 F higher in afternoon

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7
Q

Tx of fever

A
  • -most fever is well tolerated
    • <40 C (104 F) symptomatic tx only
    • > 41 emergent management
  • -anti-pyretic therapy only needed in marginal hemodynamic status
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8
Q

pediatrics & fever

–philosophy

A
  • -fever is friend

- -anti-pyretics may prolong illness

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9
Q

emergency care required when…

A
    • <2m old w/ temp >100.9 F

- - >2m temp >106 F

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10
Q

important feature to watch for in kids w. fever =

A
  • -significant change in demeanor
    1) kid act ill & not eat as much = normal
    2) not drink water, not eat food/things they like = ER/ pediatrician
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11
Q

benefits of fever

A
  • -draws attention to underlying condition
  • -therapeutic effects
  • activation of IL-1 mediated immune responses
  • increase chemotactic, phagocytic & bactericidal activities or neutrophils
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12
Q

detrimental aspects of fever

A
  • -muscle & adipose wasting
  • -myalgias & arthralgias
  • -CNS alterations (irreversible brain damage >106 F)
  • -loss of electrolytes d/t sweating
  • -trigger epileptic seizures
  • -possible birth defects w. high maternal fever (1st trimester)
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13
Q

accompaniments of fever

–systemic symptoms

A
  • -HA
  • -arthralgias
  • -myalgias
  • -tachycardia
  • -tachypnea
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14
Q

accompaniments of fever

–chills/rigors

A
  • -shaking is d/t cytokines & prostaglandins which set body temp in the hypothalamus.
  • -assoc w/ pyogenic infections w/ bacteremia or viremia
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15
Q

accompaniments of fever

–changes in mental status

A
  • -most striking in very young & old
  • -confusion
  • -slowness
  • -“sensorium clears w/ defervescence”
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16
Q

accompaniments of fever

–convulsions

A
  • -MC in children <5

- -not necessarily a sign of serious cerebral disease

17
Q

accompaniments of fever

ALL

A
  • -systemic symptoms
  • -chills/rigors
  • -sweating
  • -changes in mental status
  • -convulsions
  • -herpes labialis
18
Q

causes of fever

–infections

A
  • -bacterial
  • -viral
  • -rickettsial
  • -fungal
  • -parasitic
19
Q

causes of fever

–rheumatologic disease

A
  • -SLE
  • -polyarteritis nodosa
  • -rheumatic fever
  • -polymyalgia rheumatic
  • -giant cell arteritis
  • -still’s disease
20
Q

causes of fever

–central nervous system disease

A
  • -cerebral hemorrhage
  • -head injuries
  • -brain & spinal cord tumors
  • -degenerative central nervous system disease
  • -spinal cord injuries
21
Q

causes of fever

–malignant disease

A
  • -primary neoplasm

- -metastatic tumors

22
Q

causes of fever

–hematologic disease

A
  • -leukemias
  • -lymphomas
  • -hemolytic anemias
23
Q

causes of fever

–cardiopulmonary disease

A
  • -myocardial infarction

- -pulmonary embolism

24
Q

causes of fever

–gastrointestinal disease

A
  • -inflammatory bowel disease
  • -liver abscess
  • -hepatitis
25
Q

causes of fever

–endocrine disease

A
  • -hyperthyroidism

- -pheochromocytoma

26
Q

causes of fever

–disorder due to chemical agents

A
  • -drug rxn

- -rex to anesthesia

27
Q

fever or unknown origin (FUO)

–essential of dx

A
  • -illness of >3 weeks
  • -temp = >38.3 C OR 101 F
  • -Dx has not been made after 3 outpatient visits or 3 days hospitalization
  • -pt cannot have neutropenia OR immunosuppression
28
Q

common causes of FUO:

A 
MC = unusual manifestations of common illnesses 
Adults:
infections 25-40%
cancer 5-10%
autoimmune 10-20%
Kids:
infections 30-50%
cancer 5-10%
autoimmune disease 10-20%
--40% remain undiagnosed &amp; resolve during further investigation
29
Q

basic procedures for eval of FUO

A
  • -Hx, Px, meds
  • -review previous studies
  • -blood cultures
  • -CBC
  • -ESR
  • -urinalysis
  • -Test: syphilis & HIV
  • -renal & thyroid func
  • -serum liver & muscle
  • -serum albumin & globulin
  • -TB skin test
  • -Stool occult blood test
  • -anti-nuclear antibody assay
  • -biopsy of tissue
30
Q

2nd-level procedures for eval of FUO

A
  • -Ab CT
  • -dental x-rays
  • -sinus x-ray OR CT
  • -Lx x-ray
  • -viral, amebic, bacterial serologies
  • -blind bone marrow biopsies
31
Q

3rd level procedures for eval of FUO

A
  • -Ab Ultrasound
  • -echocardiogram
  • -bone scan
  • -laparoscopy/laparotomy
  • -small bowel OR rectal biopsy
  • -angiography
  • -therapeutic trials

Correlative and Differential Dx (7 decks)

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