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Faith's Multisystems module > FUO > Flashcards

FUO Flashcards

0
Q

1 yr old immunization unknown adoptee from china presents with a whole body brick rash (darker on the trunk) cough (crusty runny nose) and some diarrhea. Child is fussy. Differential diagnosis?

A

Measles- a very infectious agent due to viral spread through respiratory droplets. Systemic viral illness.

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1
Q

Define fever of unknown origin

A

Three outpatient visits or three days in the hospital or 1 week of “intelligent and invasive” ambulatory investigation

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2
Q

4 Categories of illnesses to consider in a recent traveler with a fever

A
  • parasitic organism (malaria)
  • enteric pathogens
  • respiratory pathogens
  • systemic viral illnesses (especially for pediatrics)
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3
Q

What are some causes of a “fever”?

A
  • infections
  • mechanical trauma (crush injury)
  • neoplasm
  • medications
  • autoimmune diseases
  • drugs
  • CNS disorders
  • acute hemolysis
  • large vascular accident
  • malignant hyperthermia
  • acute metabolic disorders (pheochromocytoma, delirium tremens)
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4
Q

Key things about fevers

do fevers = infection? What does a fever usually mean?

A

NOT infection - think inflammation

- TNF, IL1, IF

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5
Q

When you think Fever, what are the three main categories you always consider?

A

Infection
Cancer
Immune disease

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6
Q

What is fever rarely due to?

A

Disorders of auto regulation

- CNS injuries,

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7
Q

What is Dr. Petersdorf 1961’s definition of fever of unknown origin?

A
  • fever higher than 101 on several occasions
  • persisting without diagnosis for at least 3 weeks
  • at least one week of investigation at a hospital
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8
Q

How does the duration of fevers differ between infections, malignancies, and immune diseases?

A
  • Infections: typically RAPID onset/resolution., except in chronic inflammation (TB, Lyme disease, HIV, hepatitis viruses, parasites - will cause inflammation when they move/die.)
  • malignancies: usually declare themselves in WEEKS

Immune diseases: wax and wane for MONTHS/YEARS (typically less urgent), vague findings

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9
Q

What are the key questions to ask about FUO

A
  1. DURATION- series of recurrent episodes? One long episode?
  2. TEMPORAL PATTERN? Normal intervals In between? Occurring in hours/days?
  3. * is the patient ill appearing?*
    - acutely ill? Toxic (visibly in distress) unstable vital signs
    - weight loss?
    - other finding os on ROS and exam
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10
Q

What is the stepwise evaluation (history taking) for a patient with FUO

A 
Life history of health
Family risk of chronic disease (cancer, immune)
Travel- location, food/water/insect exposure
Pets/animals
Family household school exposures
History of THIS complaint: 
- onset, duration, pattern
- patient vs observers
- signs and symptoms
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11
Q

Physical exam for FUO:

A

** look for real manifestations of systemic disease- not secondhand report**

  • signs of inflammation (fever, wt loss)
  • focal pain/tenderness (dolor, rumor, tumor, calor)
  • look at common problem sites: mucous membranes, sinuses, lungs, careful abdominal exam
  • msk- joint inflammations
  • integument- health of skin: rashes?
  • liver spleen lymph nodes
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12
Q

FUO first tier of labs:

A
  • WBC (shift to PmNs), C-reactive protein, ESR
  • urinalysis, BUN, bili,
  • LDH (cancer)
  • PPD, HIV
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13
Q

Second tier of labs for FUO

A 
More exotic
Virals: ebv, Cmv, hep b and c
Bacteria: Lyme, syphillus, rickettsia, etc
Parasites: toxo, 
Autoantibodies: Ana, dsdna, sm, GI panel

Malaria smears, stool cultures,
Eye exam
Cardiac exam

repeat skin, joint, Ln, spleen liver exam

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14
Q

Imaging to do for FUO in second tier

A

Ct
MRI
U/S

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15
Q

Third tier for FUO analysis

A 
Go fishing
Lots of blood draw
Ln bm biopsy
PET scan
One central manager by now coordinating all this

Watch and wait is ok for stable pts

16
Q

18 yr oldwith lymphadenopathy and fever- fatigue, ns, myalagias, flat affect, chains of Ln inflamed, African American female

Anemic, tissue inflammation (alt ast in the 100’s), high crp, high sed rate

A

Consider autoimmune: SLE (lupus)

Ana +
Anti ds DNA+
Anti sm +

17
Q

4 yr old with parotitis- one week of fullness of neck tender, and warm. Had mumps dx 6 weeks ago, and “mumps” flared again 1 week later (rare for mumps) => recurrent parotitis?

Prolonged loss of appetite for weeks/months
Anemic
Arthritis in ankles
Low platelet count
High LDH
A

Atypical lymphoblasts- 62,000 WBC

- acute lymphocytic leukemia

18
Q

7 year old with fever. Initial fever 3 weeks ago nausea and diarrhea. Traveled all over Central America. Dramatic fevers chills3-4x/day for 10 days. Pale, quiet, noting specifically wrong with him clinically or physically.

A

Typhoid fever? Strong abx response to salmonella (common is post illness)

=> enteric fever

Faith's Multisystems module (12 decks)

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