Fever and PUO Flashcards
3 Criteria for Pyrexia of Unknown Origin?
- 2-3 week prolonged illness
- fever above 38.3C
- no dx after intelligent investigations
oral or ear temps are higher?
ear is closer to core temp
what id the diurnal pattern of temp?
lowest in morning, highest in afternoon (0.5-1.0C)
body temp regulated by?
pre-optic region of anterior hypothalamus
why is fever adaptive?
increase core temp activates immune mechanisms quicker at optimum 39.5C
Why is fever maladaptive?
expensive to maintain
rigor is feeling of?
intense cold
uncontrollable shivering
pallor
piloerection
short duration fever most likely from?
infection
self-limiting viral
What is meningococcaemia?
meningococcus septicaemia, rash, affect brain, joints etc.
why is falciparum malaria dangerous?
short liver phase, quicker onset
why post-splenectomy more susceptible to infections?
missing a big chunk of macrophages
Toxic Shock syndrome from which bacteria?
staph or strep, super antigen and get overwhelming immune response with hypotension and rash
necrotising fasciitis usually from?
group A strep pyogenes
what bug can be associated with endocarditis?
staph aureus on a damage valve
at risk patients for severe illness include?
- recent travel
- asplenics
- neutropaenics
- elderly, DM, IVDU
warning bells for acute fever?
Rapid onset
Rigors
severe muscle pain
impaired conscious
vomit
severe headache
rash
jaundice
What to be aware of for fever management?
Day 1: “Normal WCC and CRP”, improvement with panadol and IV fluids
prolonged fever: watch out for?
animal exposure TB travel toddlers meds sexual contacts
PUO differentials and percentages?
20% infections
30% CT disorders (RA, Immuno)
30% Malignancies
10% other: IVDU, benign
most common cause of SBE (subacture bacterial endocarditis)?
viridans strep
examples of CT and immuno syndromes?
RA
Polymyalgia rheumatica
acute thyroiditis
SLE
Sutton’s Law for invasive tests?
“go where the money is”
eg. biopsy
PUO in immunosupressed with what usually?
HIV
Transplantation
