fever

Question 1

DDX for nosocomial fever?

Answer 1

Nosocomial fever: Hospitalized >24 hours but no fever on admission, Evaluation >3 days

Ddx: 
C. diff enterocolitis
Drug induced
PE
Septic thrombophlebitis (vein inflammation & blood clot)
Sinusitis

Question 2

Immune-Deficient fever?

Answer 2

Neutrophil count <500/mm3 > 3 days,

Ddx: Opportunistic bact infection
Aspergillosis
Candidiasis
Herpes

Question 3

HIV related fever,

> 4 weeks (outpatient)
3 days (inpatient)
Known HIV carrier

Answer 3

CMV
MAC
Pneumocystis carinii pneumonia
Drug induced
Kaposi’s Sarcoma
Lymphoma

Question 4

diagnostic criteria for endocarditis?

Answer 4

Duke’s Criteria: 2 major criteria, 1 major + 3 minor criteria, or 5 minor criteria

MAJOR:
Positive blood culture for typical endocarditis bugs (2 separate cultures)
Echocardiogram with oscillating intracardiac mass on valve

MINOR
Predisposing cardiac condition or IVDU
Temp >38º
Vascular phenomena (emboli, infarcts, aneurisms, etc.)
Immunological phenomena (GN, Osler nodes, Roth spots, rheum factor)
Microbio evidence (positive blood culture that does not meet major criteria above)
Echo evidence (consistent with endocarditis but does not meet major criteria above)

Question 5

When to bring the patient to hospital?

Answer 5

< 3 mo old: rectal temperature >38oC (even if seems well)
3 mo → 3 years old: rectal temp >38oC for longer than three days or if sick, fussy, clingy, is not drinking fluid
3 mo → 3 years old: rectal temp >38.9oC
Oral, rectal, ear, forehead temp >40oC
Armpit temp >39.4oC
Febrile seizure
Fevers that keep coming back
Fever with underlying medical disease
Fever with new skin rash

Question 6

complicated UTI?

Answer 6

Complicated includes anything that would increase the risk of failing therapy, including:
Poorly controlled diabetes mellitus
●Pregnancy
●Hospital-acquired infection
●Acute kidney injury or chronic kidney disease
●Suspected or known urinary tract obstruction
●Presence of an indwelling urethral catheter, stent, nephrostomy tube, or urinary diversion
●Functional or anatomic abnormality of the urinary tract
●Renal transplantation
●Other immunocompromising condition (eg, chronic high-dose corticosteroid use, use of other immunosuppressive agents, neutropenia, advanced HIV infection, B or T leukocyte deficiency)

Question 7

common pathogens for acute otitis media?

Answer 7

strep pneumo, H. Influenza, moraxella