Fever Lecture Flashcards
General causes of fever
Infection
Inflammation (Rheum, connective tissue disorders)
Vascular (DVT can cause fever)
Endocrine
Malignancy
What is the reference number for a fever
38.3C or higher
100.9 F or higher
What is hyperpyrexia and what is the cause typically
41.5 or greater
CNS bleed often causes it
What is a pyrogen
Any SUBSTANCE that causes a fever
IL-1, IL-6, TNF, IFNa
What part of the brain is responsible for a fever
Hypothalamus
Which pyrogen is responsible for body aches, chills, and the other effects of a fever
Elevated Prostaglandin E2 (PGE2) in hypothalamus
What is the general pathway of a brain bleed
Fever»_space; something raises hypothalamic set point»_space; Triggers vasoconstriction and shunting of blood from periphery decreases heat loss»_space; Shivering my occur (increases heat production)
What is hyperthermia
elevated body temperature not caused by a resetting of the temperature set point
What two types of patients should you treat a fever in
- Pts who have cardiac disease- their O2 demand increases w fever, and this is bad for a pt that is already compromised
- Pts who are pulm pts (COPD, asthma, etc)
What is the best antipyretic
Acetaminophen (Tylenol)
Asprin, NSAIDS, Steroids
Conditions where a fever is absent
- TNF blockers
- Cytokine inhibitors
- Liver Disease patients
-Newborn and elderly
What other vital signs are fever usually accompanied by
-Tachycardia
-Tachypenia
-Sweating, chills
Most acute fevers are likely caused by what
viruses/ viral infections
What are the most likely infectious causes of a fever
- Upper and lower respiratory tract infections
- GI infections
- UTIs
- Skin infections
Digging up in the dirt and working in very dry dirt can predispose you to which illness
Coccidioidomycosis (Valley fever)– Fungus/Yeast, Dimorphic
Nicaragua, southern America, Africa, India, and Sri lanka all have which disease in common
Maleria
Fever, night sweats, weight loss, and a cough, equals what in ID?
TB
What are some exogenous pyrogenes
Amphetamines
Cocaine
MDMA, Ecstacy
Antipsychotics
Anesthetics
Which exogenous drugs trigger pyrogeny
Drug pyrogeny fever
Beta lactam antibiotics
Sulfa drugs
Phenytoin- Seizure drugs
Carbamezapine
Quinidine
Interferons
Ohio river valley has an endemic organism there that is called what
Histoplasmosis
Transmitted through bat droppings, which are endemic to ohio river valley
If your patient owns a turtle/reptile what are they at risk for
Salmonella
If your patient owns a cat that SCRATCHES them often, what bacteria is your patient at risk for
Bartonella henselae
If your patient owns a cat and it BITES them often, which bacteria are they at risk for
Pasteurella multocida- Treat with Ceftriaxone or penacillin, Zosyn
How do you treat Pasteurella multocida
Unasyn, Ceftriaxone, Penacillin, Zosyn, Clindamycin
Target lesions with a fever suggest which diseases
SJS, TENS, Target lesion
Petechial or purpuric rash is concerning for which diseases
Meningococcemia, RMSF
Erythema migrans suggests which diseases
Lyme disease (Causes a bulls eye target lesion)
Which diseases cause a rash on palms and soles
Rocky mountain spotted fever
TSS with strep
Scalded skin syndrome
Syphilis
Neisseria gonorrhoeae
Classic sign of psoraisis on nails
pitting
Red flags with a fever
- Altered mental status
- Headache, stiff neck
- Headache, stiff nech, petichial or purpuric rash (Worst red flag- meningitis)
- Petechial rash
- Hypotension (Low BP- could be SEPSIS, or problem w heart, could be dehydration, could be MI)
- Dyspnea
- Immunosuppressed patients
- Recent travel to areas of illness (Malaria in endemic areas)
- Temp >40C
How do you make a maleria diagnosis
Blood smear - Look under microscope, see parasites around and in RBCs
What 3 labs should you typically always order for patients with a potential ID concern
- CBC w diff/Chem 14/LFTs
- Serologies
- Cultures (“Nobody will ever fault for culture”)
What is the significance of Glucose in CSF
If glucose is low in CSF, likely dealing with a bacterial, mycobacterial, fungal (cryptococcus, particulary in AIDS patients, or cocci (valley fever)). Could be malignancy. All of those things will cause a very low glucose in CSF.
Glucose in CSF needs to stay high.
Which medication is perscribed for chlamydia
Doxycycline or azithromycin
Diagnosis of Syphilis
RPR VDRL
Serology rapid antigen
What are the good anti-MRSA drugs
Doxycycline
Linezolid (Zyvox)
vanco
bactrim
For MSSA- Diclox
Donovan Bodies
Granuloma inguinale
What are the pathomnumonic histological findings of granuloma inguinale
Donovan bodies
If a patient presents with N/V/D and it is campylobacter positive, what do you treat it with
Treat campylobacter with Azithromycin
How do you treat C. Diff
Oral Vancomycin
For pelvic salpingitis, what is the gold standard diagnostic?
laparoscopy– purulent peritineal material is noted as key finding
What is the drug of choice for campylobacter
Azithromycin
What is the drug of choice for Shigella
Ciprofloxacin or Azithromycin
What is the cause of Whipple’s disease and how do you treat it
Caused by Tropheryma whipplei.
Treated with Ceftriaxone or Penicillin, followed by Bactrim (TMP-SMX) for a year.
Arthralgia, fever, diarrhea, abdominal pain, weight loss, anorexia, increased skin pigmentation, lymphadenopathy, chronic cough, and CNS symptoms are indicative of which disease
Whipple’s Disease
