Fever Flashcards
What is the use of body temp elevation?
The elevation in body temperature
- activates T-cell production,
- increases the effectiveness of interferons 3. and limits the replication of some common viruses
Fever can be defined as an early morning oral temperature ____ or a temperature _______at other times of day
> 37.2°C
> 37.8°C
Oral temperature is about____ lower than core body temperature
0.4°C
Axillary temperature is about____ lower than core body temperature
0.5°C
Rectal, vaginal and ear drum temperatures are _____ higher than oral and reflect core body temperature
0.5°C
Fevers due to infections have an upper limit of______
40.5–41.1°C
T or F
Hyperthermia (temperature above 41.1°C) and
hyperpyrexia appear to have no upper limit
t
Drug fever should abate by _____hours after
discontinuation of the drug
48
Features of a true chill are _____ and _______ which is quite different from the chilly
teeth chattering and bed shaking,
Features of true chills
• shaking cannot be stopped voluntarily
• absence of sweating
• cold extremities and pallor (peripheral vascular
shutdown)
• dry mouth and pilo-erection: lasts 10–20
minutes
state when the body’s metabolic heat production or environmental heat load exceeds normal heat loss capacity
Hyperthermia or hyperpyrexia
This is the sudden onset of hot, dry, flushed skin with a rapid pulse, temperature above 40 ° C, and confusion or altered conscious state in a person exposed to a very hot environment
Heatstroke (sunstroke, thermic fever
In heat stroke:
The BP is usually _______
initially but circulatory collapse may precede
not affected
Mx of heat stroke
• Immediate effective cooling water applied to skin
• Icepacks at critical points (e.g. axillae, neck, head)
• Ice water bath if possible
• Aim to bring down temperature by 1 ° C every 10
minutes
This is a rare hereditary disorder characterised by rapidly developing hyperpyrexia, muscular rigidity
and acidosis in patients undergoing major surgery
Malignant hyperthermia
_______ is usually encountered in hospitalised patients attempting to malinger
Factitious fever
Characteristics of factitious fever
- a series of high temperatures is recorded to form an atypical pattern of fluctuation
- there is excessively high temperature (41.1 ° C) and above
The syndrome includes high temperature, muscle rigidity, autonomic dysfunction
and altered consciousness. It is a rare and potentially lethal reaction in patients taking antipsychotic drugs
Neuroleptic malignant syndrome
Drugs asstd with NMS
haloperidol alone or with
other drugs especially lithium carbonate
Where to put thermometer if taking oral temp
Place under the tongue at the junction of the
base of the tongue and the floor of the mouth to one side of the frenulum—the ‘heat’ pocket. (mouth shut)
How to take oral temp
The rule is ‘3 cm in for 3 minutes
How to take vaginal temp (measure ovulation)
It should be placed deeply in the vagina for 5 minutes before leaving bed in the morning.
______is now accepted standard practice.
The tympanic membrane (TM) accurately reflects ______temperature, which in turn reflects core body temperature
Otic thermography
hypothalamic
According to Yung and Stanley it is helpful to consider fever in three categories: 1 2 3
less than 3 days duration;
between 4 and 14 days duration;
protracted fever (more than 14 days).
MCC of Fever of less than 3 days duration
often due to a self-limiting viral infection
of the respiratory tract
MCC of Intermittent fever
include various pyogenic
infections, cytomegalovirus and lymphoma.
MCC Relapsing fever
Malaria (classic)
in quartan fever, caused by Plasmodium malariae
This is a fever in which the temperature returns towards normal for a variable period but is always elevated
Remittent fever
Examples of Remittent fever
pelvic abscess, wound infection, empyema and carcinoma). It is a common
feature of empyema.
_______ is characterised by bouts of continuousor remittent fever for several days, followed by afebrile remissions lasting a variable number of days
Undulant fever
Causes of Undulant fever
It is commonly a feature brucellosis infection but is also seen in the lymphomas, especially Hodgkin lymphoma
fevers lasting 3 to 10 days followed by afebrile periods of 3 to 10 days.
asstd with Hodgkins Lymphoma
Pel–Ebstein fever
In this pattern the fever recurs daily
Quotidian fever
Daily fever spikes in the morning are characteristic of ______
afternoon spikes are indicative of ____________; and
evening spikes suggest localised collection of pus (e.g. empyema of the gall bladder).
Pseudomonas infection (e.g. pulmonary superinfection);
cytomegalovirus infection
Double quotidian fever (two fever spikes in a day) is caused by adult 1 2 3
Still syndrome, gonococcal endocarditis and visceral leishmaniasis
This is fever occurring within 24 hours after surgery
Postoperative fever
MCC of Postoperative fever
- pulmonary atelectasis (common)
- wound haematoma
- deep venous thrombosis
- myocardial infarction
- allergic drug reaction
In children, most authorities would consider a fever of_______ and above to be significant and warrant close scrutiny
38.5 ° C
T or F
Hyperthermia is common in children
F
uncommon
MCC of hyperthermia (41C)
usually due to CNS
infection or the result of human error
febrile convulsions, which occur in _____
of febrile children between 6 months and 5 years
5%
Febrile convulsions are triggered by a_______rather than its absolute level
rapid rise in temperature
Tx of high grade fever in children
Use 20 mg/kg as a loading
dose and then 15 mg/kg maintenance
• Any fever in the elderly is significant.
• ________ is a less common cause of fever in the elderly.
• Fever in the elderly is______ until proven
otherwise (common sites are the lungs and
urinary tract).
Viral infection
sepsis
The syndrome consists of hyperpyrexia, decreased sweating, delirium
and coma. The core temperature is usually over 41 ° C.
Heatstroke
Criteria for FUO
- illness for at least 3 weeks
- fevers >38.3 ° C (100.9 ° F)
- undiagnosed after 1 week of intensive study
Fever in children is usually a transient phenomenon and subsides within ______ days. At least 70% of all infections are ___
4–5
viral
MCC of FUO in chidlren
Infectious causes (40%)
Collagen–vascular disorders (15%)
Neoplastic disorders (7%)
Inflammatory diseases of the bowel (4%)
MCC of FUO from neoplasm
- Leukaemia
- Reticulum cell sarcoma
- Lymphoma
Initial empirical Tx of septicemia
Empirical initial
treatment (after blood cultures) is di/flucloxacillin 2 g
IV 1 gentamicin 4–6 mg/kg IV (statim).
The transient presence of bacteria in the blood (usually asymptomatic) caused by local infection or trauma
Bacteraemia
The multiplication of bacteria or fungi in the blood, usually causing a systemic infl ammatory response (SIRS).
Septicaemia (sepsis
SIRS is defined as 2 or more
of (in adults
temperature >38°C or <36°C
• respiratory rate >20/min
• heart rate >90/min
• WCC >12 × 109/L or <4 × 109/
Sepsis associated with organ dysfunction, hypoperfusion or hypotension with
2 or more of: fever, tachycardia, tachypnoea, and elevated WCC.
Severe sepsis
Sepsis with critical tissue perfusion causing
acute circulatory failure including hypotension
and peripheral shutdown—cool extremities, mottled skin, cyanosis
Septic shock
A serious manifestation of septicaemia
whereby organisms and neutrophils undergo embolisation to many sites, causing abscesses, especially in the lungs, liver and brain
Pyaemia
______ where the focus of
infection is not apparent, while in secondary septicaemia a primary focus can be identifi ed
Septicaemia
