fever and immune mediated disease

Question 1

fever vs hyperthermia

Answer 1

fever- raised thermoregulatory setpoint

hyperthermia- abnormalities of heat production/dissipation

Question 2

causes of fever

Answer 2

neoplasia, infection, immune mediated disease, inflammation

Question 3

define fever of unknown origin

Answer 3

fever lasting long enough that self limiting causes are r/o, initial diagnostics dont reveal cause, may not respond to abx

Question 4

approach to working up fever

Answer 4

C/S, hx, PE, dx

Question 5

important history questions for fever

Answer 5

travel hx, recent meds, hx trauma/fighting, recent heat, other animals/huamsn showing signs?

Question 6

thing to look for on PE for fever workup

Answer 6

heart murmur, joint effusion, spinal pain, bone pain, bite wounds

renal pain, organ enlargement, rectal, masses, URT signs, lung auscultation

lymphadenopathy, 3rd spacing, oral exam, ocular exam, derm lesions

Question 7

name some first tier diagnostics for fever

Answer 7

CBC w blood smear, chem, UA, urine culture, imaging

Question 8

name some second tier diagnostics for fever

Answer 8

serial PE, blood culture, imaging, joint taps, 4DX, FNA, CSF, biopsy

Question 9

autoimmune diseases are mediated by

Answer 9

Th2 cells, autoAb
- autoAb production
-opsonized cells cleared by macrophages/complement
- inflammatory cytokines

Question 10

primary vs secondary immune mediated disease

Answer 10

primary- idiopathic, dx of exclusion
secondary- underlying cause/infection

Question 11

systemic lupus erythematosus
signalment

Answer 11

multisystemic autoimmune disorder-> Ab against nucleus-> opsonization, immune complexes

middle aged dogs, GSD, duck toller

Question 12

lupus C/S

Answer 12

fever, lameness, joint swelling, proteinuria (glomerulonephritis)
cutaneous- UV exposure, mucocutaneous junction

Question 13

lupus diagnosis

Answer 13

difficult to dx, r/o underlying disorders
antinuclear antibody test (ANA)-> can have false +ve in normal animals so make sure C/S line up
LE cells-> not sensitive but specific (seen in joint fluid, blister fluid)

positive signs + ANA test, or 3+ signs w negative ANA

Question 14

lupus tx and prognosis

Answer 14

immunosuppressives, tx IMHA, PLN
supportive care
prognosis variable, relapse possible

Question 15

joint disease types (2 basic ones)

Answer 15

inflammatory (infectious or immune mediated)
non-inflammatory (DJD, degenerative, trauma, tumour)

Question 16

septic vs sterile inflammatory joint disease?

Answer 16

septic- single swollen painful joint, hx trauma, current infection
sterile- multiple joints, hx of abx, vx

Question 17

when to tap joint?

Answer 17

solitary joint disease with signs of inflammation/illness
evidence of polyarthritis
FUO

Question 18

normal vs abnormal joint fluid

Answer 18

normal: clear, colourless, viscous
low cells <2/hpf, <10% neutrophils

abnormal: turbid/cloudy, discoloured
high cells, >20% neutrophils, bacteria

Question 19

types of fluid for:
normal
sterile inflammatory
septic
degenerative/traumatic

Answer 19

low cells, mononuclear
high cells (>3000), non degenerative neutrophils
high cells (150000), degenerate neutrophils, bacteria
low, slightly increased, mononuclear

Question 20

types of immune mediated joint disease

Answer 20

erosive, non erosive

Question 21

erosive polyarthritis

Answer 21

uncommon
subchondral bone destruction, carpus affected
sm middle aged dogs

Question 22

types of non erosive immune mediated polyarthritis

Answer 22

primary (idiopathic)-> no inciting cause, middle aged dogs most common

reactive-> infectious, medication rxn, neoplasia, dietary (uncommon)

Question 23

IMPA clinical signs

Answer 23

lameness, stiff gait, walking on eggshells
joint pain/swelling
inappetence, lethargy, weight loss, weakness, v+, fever
polysystemic signs-> derm signs, ulcers

Question 24

IMPA PE findings

Answer 24

fever (FUO), stiff gait, joint effusion
neck/back pain

Question 25

IMPA diagnosis

Answer 25

joint tap- neutrophilic in mutliple joints, negative culture
check for underlying disease->CBC/chem/UA, tick borne disease testing (4DX), cultures (urine, blood), imaging

Question 26

IMPA tx and monitoring

Answer 26

pred
monitor C/S (lameness, etc)
joint taps (1m before tapering pred)- if still inflammed add second line (cyclosporine)