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Medicine MBBS > Infectious diseases,... > Flashcards

Infectious diseases,... Flashcards

1
Q

Investigations to be done when a patient is presented with fever

A
  1. a full blood count
  2. urea and electrolytes, liver function tests, blood glucose and muscle enzymes
  3. Inflammatory markers, ESR, CRP
  4. Auto antibodies and antibodies to HIV 1
  5. chest x-ray and ECG
  6. urine culture
  7. blood culture, throat swab
  8. PCR
  9. other specimens history and examination
  10. Specific tests geographical location
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2
Q

Prominent causes of pyrexia of unknown origin in old age

A
  1. TB
  2. Intra-abdominal Abscesses
  3. Complicated urinary tract infections
  4. Infective endocarditis
  5. Poly myalgia rheumatica
  6. Temporal arteritis and tumours
    A small fraction of cases remain undiagnosed than young people
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3
Q

Management of fever

A

Buy paracetamol and by tepid sponging to cool the skin
Replacement of salt and water is important in patients with drenching sweats
Further management is based on underlying cause

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4
Q

Diurnal variation of body temperature

A

Oral temperature is 37.2°C at 6 AM and 37.7°C at 4 PM that is it varies between 98.9°F and 99.9°F

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5
Q

Methods of monitoring temperature

A

Peripheral methods:
Tympanic membrane temporal artery axillary, and oral thermometry

Central methods:
Pulmonary artery catheter, urinary bladder, oesophageal and rectal thermometer

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6
Q

Differences between the various temperatures of the body

A
  1. Rectal temperature is higher then oral by .4°C. Oral temperature is lower due to mouth breathing
  2. Unadjusted tympanic membrane readings are 0.8°C or 1.6 F lower than rectal temperature
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7
Q

Hyperthermia

A

It is defined as the elevation of core body temperature above the normal diurnal range of 36 to 37.5°C due to failure of thermoregulation
Severe hypothermia is when the temperature is above 40°C or 104° F

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8
Q

Malignant hyperthermia

Nature and causes

A

Malignant hyperthermia is a autosomal dominant disorder that manifests often following treatment with anaesthetic agents most commonly succinylcholine and halothane
Pathological and controllable increase of heat production

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9
Q

Features of malignant hyperthermia

A
  1. Initial muscle rigidity especially masseter stiffness
  2. Sinus tachycardia
  3. Hypercarbia and skin cyanosis

Marked hyperthermia up to 45°C or 113° F occurs a few minutes to hours later

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10
Q

Neuroleptic malignant syndrome (NMS)

A

Life threatening neurological emergency associated with the use of antipsychotic neuroleptic agents
Clinical syndrome of mental status change rigidity ,fever and dysautonomia

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11
Q

Neuroleptic malignant syndrome (NMS) is caused by the antipsychotic agents

A 
Haloperidol
Fluphenazine
Chlorpromazine
Clozapine
Risperdone 
Metoclopramide
Promethazine
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12
Q

Hyperpyrexia

A

Fever more than 41.5°C or 106.7° F

Severe infections, central nervous system or haemorrhages

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13
Q

Set point of hypothalamus is raised by

A

PGE2
This activates:
1. neurons in the vasomotor centre for vasoconstriction
2. warm sensing neutrons to slow their firing rate and increase heat production in the periphery

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14
Q

Methods of heat production in humans

A
  1. Shivering thermogenesis
  2. Non-shivering thermogenesis (eg brown adipose tissue)
  3. Increased metabolic activity
  4. Behavioural changes
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15
Q

Causes of hypothalamic fever

A
  1. Local trauma
  2. Haemorrhage
  3. Tumour
  4. Intrinsic hypothalamic malfunction
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16
Q

Examples of pyrogens

A
  1. Exogenous-toxins
    Endotoxins from E. coli and Klebsiella
    Enterotoxins from S. aureus and S. pyogenes
  2. Endogenous-cytokines like IL-1 beta, TNF – alpha, IL-6
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17
Q

Continuous or sustained fever

A

Continuous or sustained fever is defined as fever that does not fluctuate more than 1•C (1.5•F) during 24 hours, but at no time touches normal

18
Q

Examples of continuous or sustained fever

A
  1. Lobar and gram negative pneumonia
  2. Typhoid
  3. Acute bacterial meningitis
  4. Urinary tract infection
19
Q

Step ladder fever

A

Fever characterised by slow step wise temperature rise and the high plateau
Classical of typhoid fever

20
Q

Intermittent fever

A

The fever is present only for several hours during the day
Examples:
Malaria, Kala Azar
Pyogenic infections, lymphoma , septicaemia
Tuberculosis, Schistosomiasis
Leptospira, Borrelia

21
Q

The various periodicities of malarial fever

A

Quotidian: 24 hr-P. falciparum
Tertian: 48 hr-P. ovale
Quartan: 72 hr-P. malariae

22
Q

Pel Ebstein fever

A

Pel Ebstein fever is an intermittent low grade fever characterised by 3-10 days of fever with subsequent a febrile period of 3-10 days

Typical rare manifestation of Hodgkin’s lymphoma

23
Q

Remittent fever

A

Remittent fever is defined as fever with daily fluctuations exceeding 2°C but at no time touches normal

24
Q

Examples of remittent fever

A

Infective endocarditis
Rickettsial infections
Brucellosis

25
Q

Relapsing fever

A

Relapsing fevers refer to those that are recurring and separated with low grade fever or no fever

26
Q

Relapsing fevers are seen in

A 
Malaria
Lymphoma
Borrelia
Cyclic neutropenia
Rat bite fever
27
Q

Recurrent fevers

A

Partial treatment of deep-seated infections like abscesses
Due to recurrent exposure to allergens in hypersensitivity pneumonitis
Drug fever
Cyclic neutropenic fevers
Cancer and pulmonary embolism – tissue necrosis
Relapsing fever is due to episodic spirochetemia

28
Q

Fever defervescence range

A

Effective antimalarial therapy leads to fever defervescence by crisis (within hours) whereas
in typhoid fever resolution occurs by lysis (gradually over days) following effective antibiotics

29
Q

Aseptic fever is caused by

A 
Non Infectious cases like:
Drugs –rifampicin, methyl dopa
Connective-tissue disease
Malignancy
Thyroid storm
Heat stroke
Pontine haemorrhage
Radiation sickness
Overatropinisation
30
Q

Fever with rash

A 
Measles – fourth day of fever
Infectious mononucleosis 
Meningococcaemia
Scarlet fever
Rubella- 2/3 rd day fever
Enteric fever – end of first week
Dengue
Scrub typhus
31
Q

Naprosyn test

A 
When naprosyn (naproxen 375 mg twice daily), or other NSAIDS [51], is given for three days, fevers due to cancers display a rapid and sustained decline while
little or no changes was observed in fever due to infectious diseases
32
Q

Temperature – pulse dissociation or relative bradycardia is seen in
(Faget’s sign or violation of the Liebermeister’s rule)

A 
Typhoid fever
Brucellosis
Leptospirosis
Leishmaniasis
Legionnaires disease
Psittacosis 
Yellow fever
Drug induced fever
Factitious fever
33
Q

Nociceptor cough

A 
Via C-fibre nociceptor
By:
1. Local anaesthetics
2. TRPV1 antagonists
3. TRPA1 antagonists
4. Na+ channel blockers
5. Opioids
34
Q

Mechanoreceptor cough

A
  1. Local anaesthetics
  2. Cl- channel blockers
  3. Na+/K+ ATPase inhibitors
35
Q

Causes of impaired cough

A
  1. Decreased respiratory muscle strength
  2. Chest wall or abdominal pain
  3. Chest wall deformity
  4. Impaired glottis closure or tracheostomy
  5. Tracheobronchomalacia
  6. Abnormal airway secretions
  7. Central respiratory depression (anaesthesia, sedation, coma)
36
Q

Etiology of cough

A 
1. Acute: 3 weeks
 RTI, aspiration, chemical inhalation
2. Sub acute: 3-8 weeks
 Irritation persisting after tracheobronchitis, pertussis
3. Chronic: 8 weeks
37
Q

Chronic cough with normal CXR

A
  • ACE inhibitor therapy
  • Air pollution
  • GERD
  • Post-nasal drip
  • Cough-variant asthma
  • Chronic eosinophilic bronchitis
  • Cough hypersensitivity syndrome
38
Q

Hemoptysis can be of ___ types (based on causes)

A
  • Infectious
  • Vascular
  • Malignancy
  • Mechanical/others
39
Q

Central cyanosis characteristics

A
  • Generalised
  • Warm affected parts
  • Does not disappear on application of warmth
  • Cyanosis may disappear in pulmonary case (except in right to left shunt) when oxygen is supplied
  • Tongue is always involved
40
Q

Characteristics of peripheral cyanosis

A
  • Localised
  • Cold affected part
  • Disappear on application of warmth or when oxygen is supplied
  • Tongue is never involved
41
Q

Causes of central cyanosis

A 
1. Decreased arterial oxygen saturation
 A. Decreased atmospheric pressure
 B. Impaired alveolar function
 C. Anatomical stunts 
 D. Hb with low affinity for oxygen
  1. Hb abnormalities
42
Q

Peripheral cyanosis

A
  1. Reduced cardiac output
  2. Cold exposure
  3. Redistribution of blood flow from extremities
  4. Arterial obstruction
  5. Venous obstruction

Medicine MBBS (1 decks)

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