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fever Flashcards

1
Q

whats dose mean fever ?

A

increase in the temprture more than 37.8C

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2
Q

what the differanc between the recal axillarly and ear drum and skin temprture ?

A

rectal and eardrum is higher by 0.4

while the acillary and skin lower by 0.4

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3
Q

whts the hyperpyrexia ?

A

temprture is more than 40

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4
Q

what the most common cause of pyrixia of unknown etiology ?

A

a common disese presented in atypical way

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5
Q

what the old and new defintion of fever pf unknown cause

A 
old 
---- 
1- temp more than 38.3c 
2- fever last for 3 week 
3- no dignosis for 1 week

3 out visit and stay at hospital for 3days and no dignosis

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6
Q

what the most common causes of the PUO?

A

1- infection (40-60)
2-malignency (20)
3-CT disease disorder (15)
4-miscellaneous (20)

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7
Q

whatre the type of infection cause pyrexia ?

A

1-abscess in liver ,renal and colon

2- infection in the oral cavity
3- bone and joint infection
4-infective endocarditis

organism 
--------
Tuberculosis 
HIV -1
CMV and EBV
fungal infection

من السفر
1- imported infection
2-nosocomial infection
3- HIV +

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8
Q

whatre the type of malignency ?

A

1- heamatological
as leukemia and lymphoma

2-soild tumeer
in the liver in the kidney ,….

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9
Q

what are the CT disese in the older age ?

A

polymalgia rheumatica

and temporal arteritis

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10
Q

whatre the CT disese in the younger age ?

A

PB SV

1- polymitosis
2- بهجت disease
3-still disease juvenile rheumatoid arthritis
4-SLE

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11
Q

whatre geogrophic contriction in CT disese ?

A

rhumatioid fever

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12
Q

whatre CT disese ?

A

polymalgia rhumatica
temporal arteritis

young 
--------
still disese 
systemic lupus arthritis 
بهجت disease 
polymitosis

rhumatoid fever

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13
Q

whatre te micellenous causes of the fever ?

A

1- cardiovacular
aterial myxoma and aortitis and aortic disection

2- haemtological
haemtological anemia ,thrombocytopenic purpra and graft versus host disease

3-GIT
Inflalmmtory bowel disease and pancreatitis and heptitis

4- endocrine/metabolic
Thyrotoxicosis, phaeochromocytoma, adrenal insufficiency, hypertriglyceridaemia

5-inherted
mediterian fever and periodic fever syndrom

6-drug reaction
antibiotic and drug hypersensivty

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14
Q

whatre the causes of drug fever ?

كلششش مهم

A

1- hypersensivty to the drug as
pencillin ,methyldopa, sulfa

2- malignant hyperthermia
(high fever + muscle contraction ) cause is the general
anesthesia

Neuroleptic malignent syndrom NMS
reaction happen due to epilyptic and anti-pschatric drug

3- fever related to the action of the drug
as J-H reaction
means having fever and skin rash after taking pencillin for syphilis

4- drug adminstration related to the fever
amphotercin B And belomycin

5- MAO inhibtors (antidepressent ) drug affect of thermoregulation

6-pharmacological action

jarsh herxheimer reaction ( after using the antibiotic that causing dath to the organism )

tumer cell necrosis by cytotoxic drugs

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15
Q

whats the factitious fever?

A 
1- pt ahve high fer more than 41c 
2- but looks well
3-no sweating 
4-noraml ESR and Creactive protein 
5-normal tempruture during observed measurment

Evidence of self injection

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16
Q

how to take history of pt PUO?

A

1-duration and the charector of the fever

2- contact with other people with same syptomas

3- history of travel conona and malaria

4-expose to the pet and past medical list

5-assocaited syptomas

if fever + weight loss + LN enlargment =lymphomaand leukemia

if fever +skin rash +arthritis = SLE and juvenile arthritis

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17
Q

whatre the causes of of fever and skin rash ?

A

كرم ت

1-Chichen box 
2-Rubella 
3-Measls 
4-typhus 
5- typhoid

+ some drugs

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18
Q

whatre the cause of fever and lymphadenoathy ?

A

بسكت
bsct

1- brucellosis
2-syphilis
3-CMV/EBV/Aids

4-toxoplasmosis

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19
Q

fever and jaundice causes ?

A

heptitis
and cholangitis

malaria and yellow fever

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20
Q

fever and pulmanry involvment ?

A

1-influenza
2-pnemonia
3-SARS and MERS

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21
Q

whtre the proment causes of the fever in elderly ?

A

1- infection as Tb intarabdomianl abscesss UTI and infective endocarditis

2- Ct disease as polymalgia rhumatica / temporal arteritis tumer

mainly attributable to malignancy in older patients

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22
Q

fever should be treated in the fallowing:

A 
1- elderly 
2- childern with fit 
3-pregnent 
4-temperture more than 39C 
5- preexisting disease like IHD Strok and pulmnary diseas
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23
Q

what is the mortality ration of PUO

A

30-40%

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24
Q

the common cause of the PUO ?

A

infection

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25
Q

common disease presenting in abnormal way ?

A

true

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26
Q

3 viral example of PUO

A

HIV virus came from outside like corona
EBV
CMV

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27
Q

Endocrine cause of PUO

A

Thyrotoxicosis
Phaeochromocytoma
Adrenal insufficiency

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28
Q

what are the possible cause in fever 10 day s develop skin rash

if it not typhoid ? what could be

A

1- Typhoid fever

2-drug allergy as Infectious mono nuclesis /Sulfa drug

29
Q

what is drug fever?

A

Fever that develope due to drug action or due to its effect on thermoregulation or hypersensitivity

30
Q

what are the pattern of fever in typhoid

A

Stepladder

31
Q

what are the sequence of symtoms after the low grade fever

A

headach ,malaise ,bradycardia and constipation

32
Q

what are the signs in the second week

A 
fever 
Cough 
Abdomenal distention 
Diarrhea 
Rose sopt
spleenomeglay
33
Q

Dx test in typhoid

A

1- blood culture for blood and BM
2-widdle 4 raise
3- aglutination

34
Q

How you treat pregnant lady with typhoid?

A

third-generation cephalosporins and ampicillin/amoxicillin

35
Q

what’re the metabolic causes of the fever ?

A

Thyrotoxicosis, phaeochromocytoma, adrenal insufficiency, hypertriglyceridaemia

36
Q

what’re the heamatological causes of the fever ?

A

1-Haemolytic anaemia

2-thrombotic thrombocytopenic purpura,

3-myeloproliferative disorders

4-graft-versus-host disease

37
Q

what’re the inherted disese that causing the fever ?

A

1-Familial Mediterranean fever حمى الشرق الاوسط

2- periodic fever syndromes

38
Q

what’re the GIT problem which causing fever ?

A

1- Inflammatory bowel disease
2-hepatitis
3- pancreatitis

39
Q

what’re the pulamnary problem that causing the fever ?

A

1-pulmonary embolism

2-extrinsic allergic alveolitis

40
Q

what’re the cardiac problem that can causing the fever?

A

1-Atrial myxoma
2-aortitis
3-aortic dissection

41
Q

which type of drugs causing fever ?

A

cytotoxic drugs — casing fever by it’s Pharmacological action of the drug Jarish-Herxheimer reaction

-MOA inhibitors can causing fever by effecting on thermoregulation

+They are best known as powerful anti-depressants, as well as effective therapeutic agents for panic disorder and social phobia.

-Amphotericin B is an antifungal medication used for serious fungal infections
Bleomycin is a medication used to treat cancer.

these can causing fever only by adminstration

  • JH reaction was defined as presence of fever (temperature, >38.0°C) and/or acute exacerbation of maculopapular skin rashes within 24 hours of receipt of penicillin therapy for syphilis.
  • Malignant hyperthermia (MH) is a disease that causes a fast rise in body temperature and severe muscle contractions when someone with MH gets general anesthesia. MH is passed down through families. Hyperthermia means high body temperature
  • Neuroleptic malignant syndrome (NMS) is a life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication. Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate.
  • Hypersensitivity ( Penicillin, methyldopa, Sulpha)
  • Amoxicillin rash in patients with infectious mononucleosis

infectious diseases are the most common causes related with fever and rash, but it is also important to consider rheumatic and neoplastic diseases, drugs, allergens, and sometimes idiopathic causes.
common infectious diseases with fever and rash are transmitted by vector: Typhus, rickettsial spotted fever, Rocky Mountain spotted fever, Lyme disease, ehrlichiosis, and tularemia

42
Q

what’s the Factitious fever?

A

Factitious fever is one of the causes of fever of unknown origin. It is usually an atypical presentation of a common disease
It represents a large group of false illnesses varying from malingering to personality disorders.

1-patient who looks well
2-Temperature > 41°C
3-Normal temperature during supervised (observed) measuremen
4-Absence of sweating

5-Normal ESR and CRP despite high fever

مخطط درجة حرارة غريب مع عدم وجود اختلاف نهاري
6-Bizarre temperature chart with absence of diurnal variation

7-Evidence of self-injection

+Factitious Fever is more common amongst medical and paramedical staff e.g. nurses, pharmacists, bacteriologist,
because of the prompt attention
Fever can also be produced by self inoculation of bacterial cultures, toxoids and milk. Cases of recurrent abscesses, cellulitis and self inflicted skin lesions due to self injection of tetanus toxoid, coliform bacilli
wo subgroups of patients with factitious disease are seen. First group comprises of younger patients who manipulated their thermometers after a genuine episode of fever; just to gain atten-
+-+0tion. Their psychopathology varies. The second group is of older subjects with serious underlying psychiatric ifiness (borderline syndrome). They create illness by self infection. The term borderline syndrome is applied to a heterogenous group of patients whose personality varies between neurosis and psychosis (Knight, 1953; Grinker et al., 1968; iCernberg, 1967; Gunerson and Singer, 1975; Stone, 1977; Perry and Klerman, 1978). Borderline cases have defects in theif self concepts, reality testing, and impulse control. They are superficially social but have feelings of hidden anger, hostility and self destruction.

43
Q

fever from travel

A

HIV , Corona , Malaria
الي يجي من ايران كورونا
من امريكا ايدز
من الهند ملاريا

44
Q

fever caused by Exposure to pets and other animals or unpasteurized milk?

A

leptospirosis, cat scratch dis

Leptospirosis is a relatively rare bacterial infection that affects people and animals. It can pass from animals to humans when an unhealed break in the skin comes in contact with water or soil where animal urine is present. Several species of the Leptospira genus of bacteria cause leptospirosis.

45
Q

fever + skin rash + arthritis means ?

A

1-SLE

2-Juvenile arthritis

46
Q

fever + cough +wt. loss+ lymph node means

A

lymphoma, Leukemia

47
Q

Fever + skin rash after one day means

A

Chicken pox

48
Q

Fever + skin rash after 2 day means

A

Rubella

49
Q

Fever + skin rash after 3 day means

A

Measles

50
Q

Fever + skin rash after 4 day means

A

Typhus

51
Q

Fever + skin rash after 5 day means

A

typhoid

52
Q

Fever and lymphadenopathy

A

1-Brucellosis unpasteurized milk malta fever also causing spleenomegly البقره

2-Toxoplasmosis, القط

3-CMV, EBV, AidsHIV —-sex

4-Syphilis
Syphilis is a bacterial infection usually spread by sexual contact. —sex

53
Q

Fever and Jaundice

A

1-Cholangitis
2-hepatitis ,
3-malaria ,
4-yellow fever

54
Q

Fever and pulmonary involvement

A

Influenza
Pneumonia
Sever Acute Respiratory syndrome SARS, MERS

55
Q

investigation of PUO ?

A 
A- Microscopy
B. Culture
C. Antigen detection
D. Nucleic acid detection(PCR)
E. Immunological tests

1-Serology (antibody detection) for viruses, fungi and bacteria and protozoa
2. Interferon-γ release assay for diagnosis of TB

F- Additional investigations in PUO

56
Q

what’s the microscbical investigation include ?

A

1-Blood for atypical lymphocytes (EBV, CMV, HIV-1, hepatitis viruses or Toxoplasma gondii), trypanosomiasis, malaria.

  1. Stool for ova, cysts and parasites
  2. Urine for RBC, WBC , schistosome ova
  3. Sputum for mycobacteria, fungi
5. Biopsy : light microscopy (mycobacteria, fungi, Leishmania) 
                electron microscopy (viruses, protozoa )
57
Q

what’re the cultures of fever?

A
  1. Aspirates and biopsies (e.g. joint, deep abscess)
  2. Blood, including prolonged culture and special media
  3. Sputum for mycobacteria
  4. Cerebrospinal fluid (CSF)
  5. Stool and Urine
58
Q

Antigen detection include

A
  1. Blood e.g. HIV p24 antigen,
  2. CSF for cryptococcal antigen
  3. Bronchoalveolar lavage fluid for Aspergillus
  4. throat swab for respiratory viruses
  5. Urine, e.g. for Legionella antigen
59
Q

PCR include

A
  1. Blood for Bartonella spp. and viruses
  2. CSF for viruses and bacteria
  3. throat swab for viruses
  4. Bronchoalveolar lavage for resp. Viruses
  5. Tissue specimens, e.g. for Tropheryma whipplei
  6. Urine e.g. for Chlamydia trachomatis, Neisseria g.
  7. Stool e.g. for norovirus, rotavirus
60
Q

Serology

A

(antibody detection) for viruses, fungi and bacteria and protozoa

61
Q

Interferon-γ release assay

A

for diagnosis of TB

62
Q

TB DIGNOSIS

A

Interferon-γ release assay
microscopical biobsy
microscopy Sputum

63
Q

Additional investigations in PUO

A 
Serological tests
  Autoantibody screen, Complement levels 
Echocardiography
Ultrasound of abdomen
CT/MRI of thorax, abdomen and/or brain
Imaging of the skeletal system
  Plain X-rays, CT/MRI spine, Isotope bone scan
Labelled white cell scan
Positron emission tomography (PET)
Biopsy
Bronchoscopy and lavage , 
Lymph node aspirate or biopsy
Biopsy of liver
Bone marrow aspirate and biopsy
Temporal artery biopsy
64
Q

what we do for the blood investigation ?

A 
- microscpoe  
atypical lymphocytes (EBV, CMV, HIV-1, hepatitis viruses or Toxoplasma gondii), trypanosomiasis, malaria.
  • culture
  • antigen HIV p24 antigen

-PCR
Bartonella spp. and viruses

Cat scratch disease

65
Q

what we do for the stool investigation ?

A

-microscope
ova, cysts and parasites

  • culture
  • antigen
  • PCR for norovirus, rotavirus
66
Q

what we do for the urine investigation ?

A
  • microscope
    RBC, WBC , schistosome ova
  • culture
  • antigen Legionella antigen
  • PCR for Chlamydia trachomatis, Neisseria g
67
Q

what we do for the sputum investigation ?

A

-microscope
mycobacteria, fungi

-culture
mycobacteria

-antigen
throat swab for respiratory viruses
Bronchoalveolar lavage fluid for Aspergillus

-PCR
throat swab for viruses

68
Q

what we do for the biobsy investigation ?

A 
-microscope 
light microscopy (mycobacteria, fungi, Leishmania) 
 electron microscopy (viruses, protozoa )
  • culture . joint, deep abscess
  • PCR Tropheryma whipplei

Whipple disease is caused by a type of bacterium called Tropheryma whipplei. The bacteria affect the mucosal lining of your small intestine first, forming small lesions within the intestinal wall.

There are 3 main forms of leishmaniases – visceral (also known as kala-azar, which is and the most serious form of the disease), cutaneous (the most common), and mucocutaneous

69
Q

what we do for the. CSF investigation ?

A

-culture

-antigen
cryptococcal antigen

-PCR
viruses and bacteria

medicine (12 decks)

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