Fever DSA Flashcards
Range for fever Dx
Above 100.9 F or 37.8 C
Night sweats are caused by…
Exaggeration of normal circadian temperature rhythm
What molecules are responsible for fever? Where do they act? What does it produce?
Endogenous pyrogens act at the hypothalamus and lead to an increase in local PGE2, monoamines, Na+, Ca++, etc.
3 endogenous pyrogens causing fever
IL-1
TNF
INF-alpha
What is different between TNF and IL-1?
TNF does NOT activate WBCs
Hyperthermia definition
An elevation in body temperature due to loss of homeostatic mechanisms and inability to increase heat loss in response to environmental heat, as in heat stroke.
Fever of unknown origin (FUO)
Fever lasting 3 wks or more with temps exceeding 38.3 C (100.9 F) with no Dx despite 1 wk of clinical investigation
Most common cause of fever in older patients…
Infection in RT, UT with skin and soft tissue
4 common causes of fever
Infection
AI dz
CNS dz
Malignancy
Drug fever definition
Fever coinciding w/ administration of a drug and disappearing after d/c of the drug, when no other cause for the fever is evident after careful exam/workup
Best tools for determining body temp (2)
Greatest variability is with what tool?
Electronic and infrared thermometers
Tympanic thermometer
In patients with fever, the best predictors of bacteremia are the patient’s…
Underlying diseases (renal failure, trauma, etc.)
Presence of shaking in a pt. w/ fever increases the probability of…
Bacteremia
Most common infectious causes of FUO (2)
Tb
Intra-abdominal abscesses
Most common malignancies causing FUO (2)
Hodgkin’s or non-Hodgkin’s lymphoma
Alarm symptoms associated with fever; if present, consider:
Fever > 105.8 F Rash Mental status change Dizziness/LHness Recent chemo SOB/CP
Fever > 105.8 F: CNS infection, NMS, heat stroke
Rash: Meningitis, sepsis, Rickettsia, endocarditis
Mental status change: same as rash
Dizziness/LHness: Septic shock, adrenal insufficiency, PE
Recent chemo: nosocomial infection w/ neutrophils
SOB/CP: PE, pneumonia, empyema
Causes of IE
Historically, been associated w/ heart valve damaged by RHD
Currently, healthcare contact and IVD is most common
To Dx IE, the cornerstone of diagnosis of endocarditis is…
What else is helpful?
Blood cultures
Transesophageal echo
Presenttation of endocarditis is…
When pts. who present ill, toxic or septic demand…
Vast in variability
Urgent treatment and workup
Most common cause of HF with reduced EF is…
CAD (reduced EF -> LV dilation)
Most common cause of HF with preserved EF is…
HTN w/ LVH
S3 and S4 gallops are associated with which parts of the cardiac cycle?
S3 - systolic HF
S4 - diastolic HF
What is the primary cause of myocarditis?
What causes secondary myocarditis?
Acute viral infection or post-viral immune respsone
Inflamation from non-viral pathogens, meds, chemicals, inflammatory diseases, etc.
What kind of CP is common in myocarditis?
Pleural-pericardial CP
Exam of myocarditis reveals…
Tachycardia
Gallop rhythm
Other evidence of HF or conduction defects
ECG of myocarditis shows…
It might mimic…
ECG features that suggest a higher rate of death or cardiac transplantations…
Sinus tachycardia
Intraventricular conduction abnormalities
Might mimic acute MI w/ ST changes, positive cardiac markers and regional wall motion abnormalities
Q waves or LBBB
Confirmation of myocarditis requires:
What is insensitive?
Histology/Bx
Labs (troponins, CK-MB)
Presenting SX of microscopic polyangiitis
Purpura Macules Vesicles Bullae Urticaria
