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Infectious Disease 2 > Fever of Unknown Origin > Flashcards

Fever of Unknown Origin Flashcards

1
Q

Define FUO

A

documented fever for at least 3 weeks w/ fever >38.3 C (100.94F) and of undetermined etiology after 1 week of investigation in hospital

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2
Q

infectious causes of fever

A
  • infective endocarditis
  • intra-abdominal infections
  • osteomyelitis
  • infected peripheral blood vessels
  • TB
  • kidney infection, UTI, urosepsis
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3
Q

neoplastic causes of fever

A
  • solid tumors: kidney; hepatoma

- lymphoreticular malignancy: hodgkin’s and non-hodgkin’s lymphoma

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4
Q

hematologic causes of fever

A
  • adult onset Stills Dz
  • Temporal Arteritis (GCA) - polymyalgia rheumatic
  • vasculitis syndromes: PAN and Wegener’s
  • Seropositive Dz: SLE and RA
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5
Q

misc. causes of fever

A
  • facticious (Munchausen)
  • Drug fever: abx, barbiturates, antiarrythmics, dilantin
  • sarcoidosis
  • IBD
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6
Q

taking a hx for FUO

A
  • travel
  • occupation
  • hobbies
  • exposure to animals
  • known infectious contacts
  • drug use
  • family hx
  • surgical hx
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7
Q

PE for FUO

A
  • confirm actual fever
  • assess the pattern of fever
  • a COMPLETE PE
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8
Q

lab and imaging to consider for FUO

A
  • CBC w/ smear (diff)
  • ESR, CRP, serum calcitonin
  • lytes and LFTs = CMP
  • blood C&S
  • urine C&S, UDS
  • LP - CSF for C&S if neuro sxs present
  • CXR
  • abdominal US
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9
Q

What are the MC infection etiologies of sepsis in adults?

A
  • pneumonia
  • abdominal infection
  • kidney infection
  • bloodstream infection (bacteremia)
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10
Q

define UTI

A

bacteriuria in the presence of sx

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11
Q

4 age groups at increased risk for UTI

A
  • neonates
  • girls
  • young women
  • older men
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12
Q

given appropriate UTI sx, what is the best diagnostic standard?

A

positive results on urine culture of >1000cfu/ml

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13
Q

define pyelonephritis

A

-infection of the renal parenchyma w/ clinical syndrome of flank pain or CVA tenderness in associated w/ fever, chills, prostration, n/v

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14
Q

what indicates urethritis in males?

A
  • dysuria w/ a urethral dischage
  • STDs MC cause in young adults
  • e.coli MC cause in older males
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15
Q

nl UA results

-RBCs for female

A

0-5 rbcs/hpf

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16
Q

nl UA results

-RBCs for male

A

0-3 rbcs/hpf

17
Q

nl US results

  • WBC
  • bacteria
  • leukocyte esterase
  • nitrite
A
  • WBC: 0-4 wbcs/hpf
  • no bacteria
  • no leukocyte esterase in dipstick test
  • no nitrites
18
Q

summary of a nl UA

A
  • positive nitrite or leukocyte esterase supports diagnosis of UTI
  • but negative test result doesn’t exclude it
19
Q

tx of acute cystitis in adult female

A

nitrofurantoin 100 mg BID x 7 days

20
Q

tx of pyelonephritis in adult female

A

-cipro 500 mg BID x 10-14 days
or
-amoxil/clavulanic acid 875 mg BID x 10-14 days

21
Q

tx of young male adult with cystitis

A

tx for STD w/ cephtriaxone 250 mg IM + azithromycin 1 g PO single dose

22
Q

tx of older male adults with cystitis

A

tx for e. coli with cipro 500 mg BID x 7 days

23
Q

empiric tx for inpatient management of pyelonephritis and complicated UTI

A
  • cipro 400mg IV BID
  • ceftriaxone (rocephin) 1g IV daily
  • cefotaxime 1-2g IV q8 hrs
  • pip-tazo (zosyn) 3.375mg IV q6
  • cefepime 2g IV q8 hrs
24
Q

how does urosepsis typically present?

A
  • fever
  • chills
  • lethargy
  • altered mental status
  • sx of the underlying infection: dysuria, flank pain
25
Q

define spesis

A

a suspected or proven infection w/ the presence of the SIRS criteria

26
Q

severe sepsis occurs when . .

A

when there is target organ dysfunction - such as hypotension, hypoxemia, oliguria, metabolic acidosis, thrombocytopenia or obtundation

27
Q

when does urosepsis occur?

A

when the infectious source of sepsis is an infection of the urinary or male genital tract

28
Q

prevalence of urosepsis

A

about 1/4 of sepsis cases are d/t urogenital infection

29
Q

dx of urosepsis

A

-SIRS criteria and confirmation of GU infection

30
Q

tx of urosepsis

A
  • hospitalized - often ICU

- early empiric IV abx and aggressive volume resuscitation w/ IV fluids

Infectious Disease 2 (13 decks)

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