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ECOS III Midterm > L11 - Fever Examination And Investigation > Flashcards

L11 - Fever Examination And Investigation Flashcards

1
Q

What is the definition of a fever?

A

100.4F

38C

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2
Q

What is a fever?

A

A regulated rise to a new set point of body temperature in the hypothalamus
Induced by pyrogenic cytokines —> increased heat production (e.g. shivering) or decreased heat loss (peripheral vasoconstriction)

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3
Q

What is hyperthermia?

A

Not cytokine mediated, set point of hypothalamus remains unchanged
Occurs when environmental heat load or body metabolic heat production exceeds normal heat loss capacity
Ex. Heat stroke, thyrotoxicosis, neuroleptic malignant syndrome
Can be rapidly fatal if untreated

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4
Q

Which organisms can cause a fever pattern of every other day?

A

P vivax and ovale (malaria)

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5
Q

Which organism can cause a fever pattern of every 3rd day?

A

P malariae

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6
Q

What can cause a stepwise fever pattern?

A

Typhoid fever

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7
Q

What can cause a pel-Epstein pattern of fever (lasts 3-10 days followed by afebrile period of 3-10 days)?

A

Lymphoma

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8
Q

What are the main causes of fever?

A 
Infection (viral, bacterial, fungal)
Malignancy (lymphoma)
Autoimmune (SLE)
Drugs (serotonin syndrome, neuroleptic malignant syndrome) 
Endocrinopathy (thyroid storm)
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9
Q

What are some differential dx for a fever and sore throat?

A

Viral URI, step pharyngitis

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10
Q

What are some DDx for a fever and cough?

A

Viral URI
Pneumonia
Flu
COVID

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11
Q

What are some DDx for fever and a rash?

A

Cellulitis

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12
Q

What are some DDx for fever and dysuria?

A

UTI

Pyelonephritis

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13
Q

What is sepsis?

A

Life threatening organ dysfunction caused by dysregulated host responses to infection

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14
Q

What are the key findings for sepsis?

A

Hypotension, altered mental status, acute kidney injury, coagulopathy and increased RR
May or may not present with fever

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15
Q

What are the associated sx for SLE?

A

Malar rash, photosensitivity, oral ulcers, arthritis, hx of pleuritis or pericarditis, hx of seizures or other CNS disorders, hematuria, alopecia

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16
Q

What are some commonly overlooked portions of the PE in pts with unexplained fever?

A

Dental (visible dental abscess/gum swelling? —> odonotogenic infection)
Female GU (vaginal discharge, cervical motion, tenderness? —> PID)
Bones/joints (hot red swollen joint, tender vertebral processes? —> septic arthritis, osteomyelitis)
Rectal (prostate severely tender to palpation? —> prostatitis)
Complete skin exam (abscess, cellulitis)

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17
Q

Localized LAD can help you localize what?

A

An infection

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18
Q

Generalized LAD can be a sign of what?

A

Systemic infection, autoimmune condition or malignancy

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19
Q

What is a fever of unknown origin (FUO)?

A 
Febrile illness (temp of 101F/38.3 or higher) for 3 weeks or longer without an etiology despite a one week inpatient evaluation 
Not just a new fever without an identified caused
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20
Q

What is the etiology for a FUO?

A

May be infection, auto immune, malignancy (IMADE)

Atypical presentation of common illness&raquo_space; typical presentation of rare illness

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21
Q

What is the work up for FUO?

A

Complete history and physical

Extensive lab and imaging work up

22
Q

What is on a CBC?

A

WBC, platelets, Hb, hematocrit

23
Q

What can cause leukocytosis?

A

DDx include stress, infection, malignancy, allergic reaction, medication effect (i.e. corticosteroids)

24
Q

What are some causes for leukopenia?

A

Wide differential including certain infections, malignancy, drugs, auto immune conditions
Low WBC count is a classic finding for SLE

25
Q

Sepsis can present with what?

A

A high or low WBC count

26
Q

When would monocytes be elevated?

A

Atypical infections (EBV, fungal, Protozoa, rickettsial, TB)

27
Q

What are infectious causes of thrombocytopenia?

A

Certain viral infections (EBV, CMV),hepatitis C, HIV, tick borne disease

28
Q

What are autoimmune causes of thrombocytopenia?

A

SLE

29
Q

What are malignant causes for thrombocytopenia?

A

Hematologic malignancies causing bone marrow failure or infiltration

30
Q

Thrombocytopenia can be seen in sepsis and is often due to what?

A

DIC

31
Q

What are CMP findings associated with sepsis?

A

Increased BUN and creatinine
Anion gap acidosis (with low HCO3)
Liver function test abnormalities can be a sign of multi organ dysfunction

32
Q

What is lactic acidosis?

A

Serum lactate concentration above 4mmol/L

Can be a marker of impaired tissue oxygenation due to tissue hypoperfusion

33
Q

Describe the leukocyte esterase test

A

High sensitivity, low specificity

Positive = pyuria, presence of WBCs in urine

34
Q

Describe the nitrite urine test

A

Low sensitivity, high specificity

Positive = presence of bacteria that reduce nitrate

35
Q

Specificity helps with what?

A

Ruling in a disease

SPIN

36
Q

Sensitivity helps with what?

A

Ruling out a disease

SNOUT

37
Q

Blood cultures are important to check if there are signs of what?

A

Sepsis/systemic infection
Or concern for bacteremia
Best to draw before giving abx (but do not delay abx to draw cultures)

38
Q

Presence of which organisms in a blood culture is always clinically significant?

A

Staph aureus
E. coli
Pseudomonas aeruginosa

39
Q

The presence of which organisms in a blood culture may be clinically significant but may also signify contamination?

A

Coagulate negative staph
Corynebacterium species
Enterococcus

40
Q

Describe molecular tests for COVID

A 
PCR and NAAT tests 
Detection target = viral RNA 
Specimen types = nasopharyngeal, nasal, sputum and saliva 
Turnaround time = hours, days 
High sensitivity and specificity
41
Q

Describe antigen tests for COVID

A 
Rapid tests 
Viral protein = detection target 
Specimen types = nasopharyngeal, nasal 
Turnaround time = minutes 
Low sensitivity, high specificity
42
Q

CXR is helpful in identifying what?

A

Pulmonary causes of fever

Including infectious, auto immune and malignant causes

43
Q

A focal infiltrate can be suggestive of what?

A

Bacterial pneumonia

44
Q

What are typical findings with COVID on a CXR?

A

Bilateral infiltrates

Basal and peripheral predominance

45
Q

What CXR findings are seen with SLE?

A

Pleural involvement and pleural inflammation (pleuritis)

Can see pleural effusion

46
Q

Suspected CNS infection is a medical emergency and important indication for what?

A

Lumbar puncture

47
Q

What are the symptoms of an CNS infection?

A

HA, fever, meningismus

48
Q

What does each tube test for during a lumbar puncture?

A
  1. Chemistries (glucose and protein)
  2. Cell count with diff
  3. Gram stain and culture, other micro studies
  4. Other studies as needed
49
Q

Describe bacterial meningitis

A

Deferential includes elevated neutrophils
High opening pressure
Low glucose
Elevated protein levels

50
Q

Describe viral meningitis

A

Lymphocyte predominance
Normal opening pressure
Normal glucose and protein level

ECOS III Midterm (15 decks)

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