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DOOS3 > Fever febrile illness-Table 1 > Flashcards

Fever febrile illness-Table 1 Flashcards

1
Q

What is tick bite prophylaxis in adults? Who is eligible for this tx?

A

doxycycline 200 mg po x1
Eligibility criteria :
•the attached tick can be reliably identified as an Ixodes tick that is estimated to have been attached for 36hours or longer
•preventive treatment can be started within 72 hours of the time the tick was removed
•ecologic information indicates that the local rate of infection of these ticks with B. burgdorferi bacteria is 20% or greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is the erythema migrans rash tx?

A
  • Doxycycline 100 mg po bid x 14 days
  • Amoxicillin 500 mg po tid x 14 days
  • Cefuroxime 500 mg po bid x 14 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the difference in tx for pts with 2-3rd stage involvement of the face and or arthritis?

A

Same drug just tx 14-28 days

How well did you know this?
1
Not at all
2
3
4
5
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4
Q

How does tx change if carditis or NS dz accompanies the rash?

A

Add oral or IV abx for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can lyme dz be prevented?

A
  • Wear light-colored clothes - easier to spot tick
  • Wear long pants, long sleeves
  • Use tick repellent, such as permethrin, on clothes
  • Use DEET on skin
  • Check for ticks after being outside
  • Remove ticks immediately by head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is PTLDS?

A

Post-Treatment Lyme Disease Syndrome

Pts diagnosed later in the dz that have persistent fatigue, muscle aches, and reduced concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are potential causes of fever with regional lymphadenopathy?

A
  • Pyrogenic Infections: S. aureas and group A strept
  • TB
  • Cat-Scratch Fever
  • Tularemia (ulceroglandular fever)
  • Bubonic plague
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the definition of fever of unknown origin?

A

> 38.3, 101
3 weeks long
remain undiagnosed after 3 days in hospital or 2 outpt visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the categories of FUO?

A

Classic, nosocomial, immune-deficient(neutropenic), HIV related

How well did you know this?
1
Not at all
2
3
4
5
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10
Q

What constitutes a classic FUO?

A
  • Fever > 38.3°C (101°)on multiple occasions
  • Duration > 3 weeks
  • Uncertain diagnosis after evaluation of at least 3 outpatient visits or 3 days in-hospital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are common etiologies for classic FUO?

A 
•Infection 
1/3 = intraabdominal or pelvic abscesses
Mycobacterial (TB)
CMV
Complicated infections of urinary tract
Osteomyelitis
Sinusitis
Bacterial endocarditis
•Connective Tissue Diseases
Adult Still’s disease
Giant Cell arteritis
•Malignancies
Lymphoma, especially non-Hodgkin’s
Leukemia
Renal cell carcinoma 
Hepatocellular carcinoma
•Drugs
Antibiotics, NSAIDS, antiepilectic drugs, antihypertensive drugs, antiarrhythmic drugs
How well did you know this?
1
Not at all
2
3
4
5
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12
Q

What constitutes a nosocomial FUO?

A

Hospitalization of at least 24 hrs with no fever on admission, evaluation of at least 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are common etiologies of nosocomial FUO?

A

C.Difficile, drugs, PE, septic thrombophlebitis, sinusitis (intubated patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What constitutes an immune def FUO?

A

Neutrophil count

How well did you know this?
1
Not at all
2
3
4
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15
Q

What are the common etiologies of immune def FUO?

A

Opportunistic bacterial infections, aspergillosis, candidiasis, herpes virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is it important to obtain a hx of sweating with fever?

A

Can change your ddx
Fever+ sweating+ heat intolerance may indicate hyperthyroidism
Fever+heat intolerance +no sweat may indicate ectodermal dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What conditions might you have an intermittent high spike in fever with rapid defervescence?

A
  • Pyogenic infection

* Can also occur in tuberculosis, lymphoma and juvenile rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What conditions might you have remittent fluctuating peaks and baseline that does not return to normal?

A
  • Viral infections

* Can occur with bacterial infections, especially endocarditis, sarcoid, lymphoma and atrial myxoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What conditions might you suspect is the pt has a sustained persistent fever with little or no fluctuation?

A

Typhoid fever, typhus and brucellosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What might you consider if your pt has a relapsing fever? meaning they are afebrile for one or more days in between febrile episodes?

A

Malaria, rat bite fever, Borrelia infection and lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If your pt has recurrent fever, characterized by episodes of fever of more than 6 mo duration, what should you consider?

A
  • Metabolic defects
  • CNS dysregulation of temperature control
  • Periodic disorders such as cyclic neutropenia, hyperimmunoglobulin D syndrome and deficiencies of selected interleukin receptor sites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What initial labs should you order when working up a FUO?

A

CBC and peripheral smear, ESR, CRP, Aerobic blood cultures, UA, urine culture, CXR, tuberculin skin test, electrolytes, BUN, creatinine, hepatic enzymes, HIV serology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If the cbc comes back and your pt has anemia, what should you consider?

A

malaria, infective endocarditis, IBD, SLE or tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If the cbc comes back and your pt has thrombocytosis, what should you consider?

A

Kawaskai disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

If the cbc comes back and your pt has changes in the WBC, what should you consider?

A

atypical lymphocytes may suggest a viral infection, immature forms may suggest leukemia and eosinophilia is suggestive of parasitic, fungal, neoplastic, allergic or immunodeficiency disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why should you avoid empiric tx in pts with FUO?

A

There is a chance you will mask or delay the diagnosis with use of abx or anti-inflammatory meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When should you ignore the above statement and tx empirically?

A
  • Nonsteroidal agents in children with presumed JIA
  • Antituberculosis drugs in critically ill children with possible disseminated TB
  • Patients who are clinically deteriorating and in whom bacteremia or sepsis is strongly suspected
  • Patients who are immunocompromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are characteristics of brucellosis?

A

Indolent infection with persistent fever and lethargy, osteoarticular complaints, hepatosplenomegaly and mild LFT elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When might you consider brucellosis?

A

in patients exposed to animals or animal products, especially unpasteurized cheese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the clinical presentation of leptospirosis? What puts pts at risk for this dz?

A
  • fever, rigors, myalgias, headache, cough and GI complaints
  • Occurs after exposure to animal urine, contaminated soil or water (swimming) or infected animal tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are s/s of malaria? When should you consider this?

A
  • Splenomegaly typically accompanies fever

* patients with history of travel to endemic areas, can present months after travel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What often accompanies fever in toxoplasmosis?

A

by cervical or supraclavicular lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What dz should you consider in a child with FUO and contact with aninals/dead carcasses/ingestion of rabbit or squirrel meat?

A

Tularemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is one of the most common causes of FUO?

A

UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the second most common category of FUO in children?

A

Connective tissue dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What should you consider if your pt is a child and presents with high, spiking fevers, lymphadenopathy, and an evanescent rash which may be present only when the patient is febrile and a positive ANA?

A

•Juvenile rheumatoid arthritis (juvenile idiopathic arthritis)
also look into polyarteritis nodosa and SLE

37
Q

What are the most common malignancies that cause FUO in children?

A

Leukemia and lymphoma

38
Q

You have a pt presenting with fever and you have ruled out almost all possible causes. What is something you should consider and how should you test for this?

A

Factitious fever- psych condition

Get a UA and check the temp- this is the closest to core temp

39
Q

What is familial dysautonomia?

A

Autosomal recessive disorder: autonomic and peripheral sensory nerve dysfunction results in defective temperature regulation

40
Q

What are s.s of familiar dysautonomia?

A
  • Poor swallowing coordination, excessive salivation, diminished tearing, excessive or diminished sweating, labile blood pressure, erythema or blanching of the skin
  • Impairment of deep tendon and corneal reflexes
41
Q

What are the 2 most common heritable periodic fever disorders in children?

A

familial Mediterranean fever and hyperimmunoglobulin D syndrome

42
Q

What is familial Mediterranean fever?

A

autosomal recessive disorder in individuals of Mediterranean descent with episodic fever and serosal inflammation

43
Q

What is Hyperimmunoglobulin D syndrome?

A

autosomal recessive disease with episodes of fever, skin eruptions, abdominal complaints and joint involvement and elevated serum IgD

44
Q

What is cyclic neutropenia?

A

patients are prone to fever during periods of severe neutropenia, which occur at regular intervals of 15 to 35 days

45
Q

What is tick bite prophylaxis in adults? Who is eligible for this tx?

A

doxycycline 200 mg po x1
Eligibility criteria :
•the attached tick can be reliably identified as an Ixodes tick that is estimated to have been attached for 36hours or longer
•preventive treatment can be started within 72 hours of the time the tick was removed
•ecologic information indicates that the local rate of infection of these ticks with B. burgdorferi bacteria is 20% or greater

46
Q

How is the erythema migrans rash tx?

A
  • Doxycycline 100 mg po bid x 14 days
  • Amoxicillin 500 mg po tid x 14 days
  • Cefuroxime 500 mg po bid x 14 days
47
Q

What is the difference in tx for pts with 2-3rd stage involvement of the face and or arthritis?

A

Same drug just tx 14-28 days

48
Q

How does tx change if carditis or NS dz accompanies the rash?

A

Add oral or IV abx for 14 days

49
Q

How can lyme dz be prevented?

A
  • Wear light-colored clothes - easier to spot tick
  • Wear long pants, long sleeves
  • Use tick repellent, such as permethrin, on clothes
  • Use DEET on skin
  • Check for ticks after being outside
  • Remove ticks immediately by head
50
Q

What is PTLDS?

A

Post-Treatment Lyme Disease Syndrome

Pts diagnosed later in the dz that have persistent fatigue, muscle aches, and reduced concentration

51
Q

What are potential causes of fever with regional lymphadenopathy?

A
  • Pyrogenic Infections: S. aureas and group A strept
  • TB
  • Cat-Scratch Fever
  • Tularemia (ulceroglandular fever)
  • Bubonic plague
52
Q

What is the definition of fever of unknown origin?

A

> 38.3, 101
3 weeks long
remain undiagnosed after 3 days in hospital or 2 outpt visits

53
Q

What are the categories of FUO?

A

Classic, nosocomial, immune-deficient(neutropenic), HIV related

54
Q

What constitutes a classic FUO?

A
  • Fever > 38.3°C (101°)on multiple occasions
  • Duration > 3 weeks
  • Uncertain diagnosis after evaluation of at least 3 outpatient visits or 3 days in-hospital
55
Q

What are common etiologies for classic FUO?

A 
•Infection 
1/3 = intraabdominal or pelvic abscesses
Mycobacterial (TB)
CMV
Complicated infections of urinary tract
Osteomyelitis
Sinusitis
Bacterial endocarditis
•Connective Tissue Diseases
Adult Still’s disease
Giant Cell arteritis
•Malignancies
Lymphoma, especially non-Hodgkin’s
Leukemia
Renal cell carcinoma 
Hepatocellular carcinoma
•Drugs
Antibiotics, NSAIDS, antiepilectic drugs, antihypertensive drugs, antiarrhythmic drugs
56
Q

What constitutes a nosocomial FUO?

A

Hospitalization of at least 24 hrs with no fever on admission, evaluation of at least 3 days

57
Q

What are common etiologies of nosocomial FUO?

A

C.Difficile, drugs, PE, septic thrombophlebitis, sinusitis (intubated patients)

58
Q

What constitutes an immune def FUO?

A

Neutrophil count

59
Q

What are the common etiologies of immune def FUO?

A

Opportunistic bacterial infections, aspergillosis, candidiasis, herpes virus

60
Q

Why is it important to obtain a hx of sweating with fever?

A

Can change your ddx
Fever+ sweating+ heat intolerance may indicate hyperthyroidism
Fever+heat intolerance +no sweat may indicate ectodermal dysplasia

61
Q

What conditions might you have an intermittent high spike in fever with rapid defervescence?

A
  • Pyogenic infection

* Can also occur in tuberculosis, lymphoma and juvenile rheumatoid arthritis

62
Q

What conditions might you have remittent fluctuating peaks and baseline that does not return to normal?

A
  • Viral infections

* Can occur with bacterial infections, especially endocarditis, sarcoid, lymphoma and atrial myxoma

63
Q

What conditions might you suspect is the pt has a sustained persistent fever with little or no fluctuation?

A

Typhoid fever, typhus and brucellosis

64
Q

What might you consider if your pt has a relapsing fever? meaning they are afebrile for one or more days in between febrile episodes?

A

Malaria, rat bite fever, Borrelia infection and lymphoma

65
Q

If your pt has recurrent fever, characterized by episodes of fever of more than 6 mo duration, what should you consider?

A
  • Metabolic defects
  • CNS dysregulation of temperature control
  • Periodic disorders such as cyclic neutropenia, hyperimmunoglobulin D syndrome and deficiencies of selected interleukin receptor sites
66
Q

What initial labs should you order when working up a FUO?

A

CBC and peripheral smear, ESR, CRP, Aerobic blood cultures, UA, urine culture, CXR, tuberculin skin test, electrolytes, BUN, creatinine, hepatic enzymes, HIV serology

67
Q

If the cbc comes back and your pt has anemia, what should you consider?

A

malaria, infective endocarditis, IBD, SLE or tuberculosis

68
Q

If the cbc comes back and your pt has thrombocytosis, what should you consider?

A

Kawaskai disease

69
Q

If the cbc comes back and your pt has changes in the WBC, what should you consider?

A

atypical lymphocytes may suggest a viral infection, immature forms may suggest leukemia and eosinophilia is suggestive of parasitic, fungal, neoplastic, allergic or immunodeficiency disorders

70
Q

Why should you avoid empiric tx in pts with FUO?

A

There is a chance you will mask or delay the diagnosis with use of abx or anti-inflammatory meds

71
Q

When should you ignore the above statement and tx empirically?

A
  • Nonsteroidal agents in children with presumed JIA
  • Antituberculosis drugs in critically ill children with possible disseminated TB
  • Patients who are clinically deteriorating and in whom bacteremia or sepsis is strongly suspected
  • Patients who are immunocompromised
72
Q

What are characteristics of brucellosis?

A

Indolent infection with persistent fever and lethargy, osteoarticular complaints, hepatosplenomegaly and mild LFT elevation

73
Q

When might you consider brucellosis?

A

in patients exposed to animals or animal products, especially unpasteurized cheese

74
Q

What is the clinical presentation of leptospirosis? What puts pts at risk for this dz?

A
  • fever, rigors, myalgias, headache, cough and GI complaints
  • Occurs after exposure to animal urine, contaminated soil or water (swimming) or infected animal tissue
75
Q

What are s/s of malaria? When should you consider this?

A
  • Splenomegaly typically accompanies fever

* patients with history of travel to endemic areas, can present months after travel

76
Q

What often accompanies fever in toxoplasmosis?

A

by cervical or supraclavicular lymphadenopathy

77
Q

What dz should you consider in a child with FUO and contact with aninals/dead carcasses/ingestion of rabbit or squirrel meat?

A

Tularemia

78
Q

What is one of the most common causes of FUO?

A

UTI

79
Q

What is the second most common category of FUO in children?

A

Connective tissue dz

80
Q

What should you consider if your pt is a child and presents with high, spiking fevers, lymphadenopathy, and an evanescent rash which may be present only when the patient is febrile and a positive ANA?

A

•Juvenile rheumatoid arthritis (juvenile idiopathic arthritis)
also look into polyarteritis nodosa and SLE

81
Q

What are the most common malignancies that cause FUO in children?

A

Leukemia and lymphoma

82
Q

You have a pt presenting with fever and you have ruled out almost all possible causes. What is something you should consider and how should you test for this?

A

Factitious fever- psych condition

Get a UA and check the temp- this is the closest to core temp

83
Q

What is familial dysautonomia?

A

Autosomal recessive disorder: autonomic and peripheral sensory nerve dysfunction results in defective temperature regulation

84
Q

What are s.s of familiar dysautonomia?

A
  • Poor swallowing coordination, excessive salivation, diminished tearing, excessive or diminished sweating, labile blood pressure, erythema or blanching of the skin
  • Impairment of deep tendon and corneal reflexes
85
Q

What are the 2 most common heritable periodic fever disorders in children?

A

familial Mediterranean fever and hyperimmunoglobulin D syndrome

86
Q

What is familial Mediterranean fever?

A

autosomal recessive disorder in individuals of Mediterranean descent with episodic fever and serosal inflammation

87
Q

What is Hyperimmunoglobulin D syndrome?

A

autosomal recessive disease with episodes of fever, skin eruptions, abdominal complaints and joint involvement and elevated serum IgD

88
Q

What is cyclic neutropenia?

A

patients are prone to fever during periods of severe neutropenia, which occur at regular intervals of 15 to 35 days

DOOS3 (12 decks)

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