Fever and Malignancy

Question 1

Define a fever?

Answer 1

Elevation of temp > 38.4 C, > 101 F

Question 2

Define continuous fever, intermittent/recurrent, remittent

Answer 2

Cont: fever all day and won’t fluctuate more than 1 degree C in 24 hours, like with bacterial infections

2. Intermittent: temp elevation cycles (a lot of fluctuation between normal and fever temps, like malaria or bacterial septicemia)
3. Remittent: temp above normal all day, but fluctuates MORE THAN 1 degree C in 24 hours (like endocarditis)

Question 3

Some critical noninfectous diagnoses to consider with acute fever?

Answer 3

AMI, intracranial hemorrahge, neuroleptic-malignant syndrome, transfusion reaction, pulmonary edema, sickle cell crisis, thyroid storm

Question 4

Define FUO

Answer 4

Elevated body temperature (>38.3C) persisting for more than 3 weeks without diagnosis despite one week of investigations in the hospital.

Question 5

Most likely cause of FUO?

Answer 5

Etiology: Infections 30%, Malignancy 20%, connective Tissue Disorder 15%, Miscellaneous 20%, and unknown 15%.

Question 6

Some examples of INFECTIOUS FUO’s? Among children and adults, what are most common causes of FUO?

Answer 6

1. Sepsis/abscess
2. TB
3. Dental/sinus infections
4. Bone and joint infections
5. Infective endocarditis
6. Viral infections;
   Infections, and abscess and TB, respectively

Question 7

For FUO due to infections, septicemia can be seen with _____ blood cultures; this issue is seen in ____ ____, with up to 5% of cultures remaining negative

Answer 7

negative; bacterial endocarditis

Question 8

For MALIGNANCY, which can cause FUO’s? Give me zose constitutional symptoms

Answer 8

Lymphoma, leukemia, myeloma, solid tumors (kidney, liver, colon, stomach, pancreas);
B symptoms: weakness, fatigue, anorexia, weight change, fever/chills, lumps, NIGHT SWEATS (TB and malignancy)!!!

Question 9

For CT DISORDERS, what could cause FUO? (Vin Rhymes Slams Giant Pussy)

Answer 9

1. Vasculitis
2. Rheumatoid
3. SLE
4. Giant cell arteritis
5. Polymyositis

Question 10

Misc causes of FUO?

Answer 10

Liver disease, sarcoid, drug rxns, thyrotoxicosis, hypothalamic lesions

Question 11

Define factitious fever; how might she appear?

Answer 11

Engineered by patient by manipulating the thermometer and/or temp chart;
appears well, temp OVER 41C, absence of SWEATING, normal ESR and CRP despite high fever

Question 12

Does FEELING HOT constitute a true fever?

Answer 12

NO; however, rigors/shaking chills implies a rapid rise in body temp

Question 13

What is important in the history?

Answer 13

1. Verify fever
2. Duration
3. Mode of onset
4. Community vs nosocomial exposures
5. Progression/pattern
6. Severity
7. Relieving and aggravating factors
8. Treatment received and/or outcome so far
9. Associated symptoms (localizing could indicate source of the fever)

Question 14

Symptoms you want to consider with fever?

Answer 14

Respiratory tract, GU, abdo, CONSTITUTIONAL SYMPTOMS, excessive sweating or none, night sweats, headache, delirium, muscle pain, and then

1. erythema nodosum (tibia and thought to represent a delayed hypersen reaction)
2. erythema chronicum migrans (lyme disease)
3. Neisseria (meningitis)

Question 15

For PMH and PSH, what should you look for?

Answer 15

Diabetes, inflamm disease, TB, malignancy, valve heart disease (immunocomp);
Surgery type, trauma, dental interventions

Question 16

Drug fever causes?

Answer 16

1. Penicillins and cephalosporins
2. Sulphonamides
3. Antiepileptics
4. Anti TB agents

Question 17

SH for fever?

Answer 17

Smoker, water supply, animals/birds in the home, consumption of unpasteurized milk/milk products, sexual history; travel: endemic area for malaria, any exposure to fresh water, any unprotected sex, exposure to insect bites