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Hugh's Locomotor > Fever and PUO > Flashcards

Fever and PUO Flashcards

1
Q

What investigations should be ordered for fever?

A

FBE, CRP, ESR

Renal function, Liver function

CXR

Urine and blood culture

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2
Q

Why is prolonged fever disadventageous?

A

Because fevers are highly metabolically demanding

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2
Q

Which hormone acts on the fever centre of the hypothalamus to increase the temperature set point?

A

PGE2

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2
Q

What are some signs that take longer to present in prolonged fever?

A

Cough, crepitations

Lymphenopathy/splenomegaly

Thyroid tenderness/temporal art. tenderness

Arthralgia, rash, arthritis

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4
Q

How does body temperature vary throughout the day?

A

Lowest in the morning

Highest in the afternoon

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5
Q

What will the body temperature of a person with rigors be?

A

Normal - rigors is a part of the process to increase temperature

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7
Q

What is the normal oral temperature range?

A

35.8-37.8

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8
Q

How does the body act to lose heat?

A

Sweat

Peripheral vasodilation

Reduce physical activity

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9
Q

Where in the brain is body temperature regulated?

A

In the posterior hypothalamus by heat sensing neurons

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10
Q

What are the leading causes of PUO

A

Connective tissue disorders ~30%

Malignancies ~30

Infections ~20%

Other ~10%

  • Drug
  • Factitious
  • Benign pyrexia
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10
Q

What is classic cause of intra-abdominal abscesses?

A

Amoeba that has travelled by the bile duct

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12
Q

Why is LPS a more rapid stimulator of fever?

A

Because it acts directly on the fever centre

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13
Q

What is the cut off for fever?

A

>37.2 for morning oral temperature

>37.8 for oral temperature at any time

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13
Q

Who are some at risk patients?

A

Recent travellers

Asplenic

Neutropenia

IVDU

Diabetic

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14
Q

What is piloerection?

A

Hair standing up

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15
Q

What is required for subacute bacterial endocarditis to occur?

A

Valve abnormality

16
Q

What abnormalities might you see in an FBE of someone with prolonged fever that might be diagnostic?

A

Neutrophilia left shift - greater proportion of newly produced neutrophils

Atypical lymphocytosis

Malaria

17
Q

When should meningocaemia be considered as the cause of a fever?

A

Very rapid onset of severe fever and rigors

Accompanied rash

18
Q

What infection should be considered in febrile patients with a history of contact with toddlers?

A

Cytomegalovirus infection

19
Q

When should falciparum malaria be considered the cause of a fever presentation?

A

When the patient has a recent history (within a few months) of travel to an endemic zone

20
Q

When should bacterial meningitis be considered as the cause of a presentation of fever?

A

When there is accompanied heahache and neck stiffness

21
Q

What is the approach to take with some who has PUO?

A

Take a thorough history

  • onset and duration
  • localising symptoms
  • severity

Is there really fever?

Consider risk factors

  • country of origin/travel
  • new sexual partners
  • animal contact
  • IVDU
  • occupation
  • past hx/ family hx/ new medications
23
Q

When should a necrotising soft tissue infection be considered as the cause of a presentation of fever?

A

When this is accompanied localised severe pain

24
Q

When should toxic shock symdrome be considered as the cause of a presentation of fever?

A

When there is accompanied sun burn like rash

25
Q

What infection should be considered in febrile patients with a history of animal/farm contact?

A

Psittacosis - atypical pneumonia from birds

Q fever from farm animals

26
Q

Why does fever occur?

A

Create the optimal temperature for certain enzymes to act at

27
Q

What are rigors?

A

A feeling of intense cold

Uncontrollable shaking

Striking pallor of face and limbs

Piloerection

Leaves suffers exhausted

28
Q

What are the criteria for pyrexia of unknown origin?

A

Illness for 2-3 weeks

Body temperature of 38.3 on several occasions

No diagnosis after intelligent investigations

Hugh's Locomotor (20 decks)

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