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Medicine Clerkship > Learning Objectives - Fever > Flashcards

Learning Objectives - Fever Flashcards

1
Q

Criteria for fever of unknown origin?

A

Temp >38.3 C on several occasions lasting longer than 3 weeks with a diagnosis that remains uncertain after careful evaluation for 3 outpatient visits or 3 days of hospitalization

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2
Q

Subtypes of FUO?

A
  1. Nosocomial - patient hospitalized >24 hours, no fever present or incubating on admission
  2. Immune-deficient/neutropenic - neutrophil count <500
  3. HIV-associated - recurrent fevers over 4 weeks outpatient or 3 days hospitalized
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3
Q

Common causes of fever in normal hosts?

A

Infection
Malignancy (common cause) - reticuloendothelial system (leukemia, lymphoma), others
Connective tissue disorder (vasculitis, RA)
Medication-induced

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4
Q

List 3 categories of medications known to induce fever.

A
  1. Anticonvulsants (phenytoin, carbamazepine, phenobarbital)
  2. Antibiotics (beta lactams, nitrofurantoin)
  3. Anticholinergics (TCAs, anti-histamines, sympathomimetics/cocaine)
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5
Q

Common causes of fever in patients with HIV?

A

Infection (Mycobacteria, MAC, visceral leishmaniasis)

Malignancy (Non-Hodgkin lymphoma) - less common cause compared to immunocompetent hosts

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6
Q

Common causes of fever in patients who have travelled/immigrated recently?

A 
Malaria
Dengue
Mono/mono-like syndromes
Rickettsial infection
Typhoid/paratyphoid
TB
Brucellosis
Viral hepatitis
Visceral leishmaniasis
Q fever
Chikungunya fever
African trypanosomiasis
Leptospirosis
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7
Q

Common cause of fever in IVDU?

A

Endocarditis

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8
Q

Common causes of immunocompromise?

A

AIDS
Asplenia
DM
Chronic liver disease (especially cirrhosis)
Neutropenia (chemo/immunosuppressive meds, genetic disorders)
Poor nutritional status

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9
Q

Most common infectious causes of FUO?

A
  1. Occult abscess
  2. TB (miliary more common than pulmonary in FUO)
  3. Endocarditis
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10
Q

Most common inflammatory causes of FUO?

A

Adult Still disease (most common)
SLE
Giant cell arteritis (most common if >50)

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11
Q

DDx - Fever and Fatigue with Murmur and Rash

A
  1. Acute HIV infection
  2. Acute viral hepatitis
  3. Endocarditis
  4. Hodgkin’s disease
  5. Adult onset Still’s disease
  6. SLE
    Less likely - drug fever, UTI, VTE
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12
Q

Duke’s criteria are >80% sensitive for endocarditis. What are the criteria?

A

2 major
1 major + 3 minor
5 minor
Pathologic diagnosis

Major:

  1. Positive blood cultures
  2. Evidence of endocardial involvement with either a positive echo (vegetation or abscess) or new valvular regurgitation

Minor

  1. Risk for infectious endocarditis (IVDU, prosthetic valve)
  2. Fever >38
  3. Vascular phenomenon such as emboli to the organs
  4. Immunologic phenomenon such as GN or Roth spots
  5. Microbiologic evidence that does not meet major criteria
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13
Q

Presentation of Adult Onset Still’s Disease (aka Systemic Onset Juvenile RA)

A

Arthritis, fevers, myalgias, lymphadenopathy (prominent feature), rash that comes and goes - salmon pink ,raised/flat, trunka/arms/legs

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14
Q

DDx - FUO, Diarrhea, Non-Specific Symptoms in a Patient with AIDS

A
  1. TB
  2. Hepatitis
  3. CMV
  4. MAC
  5. Endocarditis
  6. Lymphoma
  7. Protozoa
    Less likely - PJP, Cryptococcosis, Toxo, Disseminated Histo, Bartonella, Coccidiodo, Visceral Leishmaniasis
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15
Q

Work-up for fever?

A
  1. CBC with diff and smear (infection, malignancy)
  2. Liver enzymes, bilirubin, LDH
  3. Blood cultures
  4. Routine blood chemistries (kidney dysfunction/electrolyte abnormalities)
  5. UA/microscopy
  6. Urine culture
  7. CXR
  8. ANA/RF
  9. HIV testing
  10. Serologies
  11. ESR
  12. Sputum cultures
  13. PPD
  14. Stool culture and fecal leukocytes (if diarrhea)
  15. Echo (if endocarditis suspected)
  16. Abdominal/pelvic CT (abscess or lyphoproliferative disorder)
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16
Q

Serologies to order in work-up of fever?

A 
Heterophile antibody test
EBV IgM
CMV IgM
Viral hepatitis
Q fever serology
17
Q

Treatment plan for patients with FUO?

A

No conclusive evidence that the use of antipyretics is beneficial or harmful. Treat with antipyretics when fever is dangerously high (>41C), pregnant, significant cardiopulmonray disease, symptomatic relief

No evidence that steroids or empiric antibiotics have any benefit - avoid (risk of harm)
-Consider empiric steroids if strong suspicion of temporal arteritis (very high ESR, associated symptoms of polymyalgia rheumatica, tender temporal arteries, concern about vision loss)

Medicine Clerkship (15 decks)

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