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Infectious Diseases > Lecture 5: Fever of Unknown Origin & TB > Flashcards

Lecture 5: Fever of Unknown Origin & TB Flashcards

1
Q

What is the definition of fever

  • in the AM
  • in the PM

in combination w/ ________

A

Definition of Fever

> 37.2 in AM
37.7 in PM

in combination w/incr in hypothalmic set point

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2
Q

What is the nornmal range for body temp

A

normal body temp range = 35.6 - 38.2

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3
Q

Comparing Temps

  1. elderly: higher or lower than avg body temp
  2. rectal temps: higher or lower than oral and core temps
  3. What is the effect ovulation has on temp?
  4. lowest temp at what time? what time for highest?
  5. 2 things that cause incr in oral temp
A

Comparing Temps

  1. elderly = lower than avd body temp
  2. rectal temps = higher than oral or core
  3. ovulation incr temp
  4. lowest temp = 6am, highest = 4-6pm
  5. incr oral temp w/smoking + chewing
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4
Q
  1. exposure
  2. aging
  3. sepsis
  4. CHF
  5. drug OD
  6. Hypoglycemia
  7. Renal or Hepatic Failure

are all causes of what?

A
  1. exposure
  2. aging
  3. sepsis
  4. CHF
  5. drug OD
  6. Hypoglycemia
  7. Renal or Hepatic Failure

all causes of HYPOthermia

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5
Q
  1. hypothalmic lesion
  2. Thyrotoxicosis
  3. Anticholinergic blockade
  4. Exercise

are all causes of what?

A
  1. hypothalmic lesion
  2. Thyrotoxicosis
  3. Anticholinergic blockade
  4. Exercise

all causes of HYPERthermia

others (obvious): heat stroke, malig hyperthermia

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6
Q

What are 2 major benefits of fever

A
  1. decr viral replication to fight infxn

2. suppress microbial growth

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7
Q
  1. incr immunoglobulin synthesis
  2. activation of T cells
  3. incr cytokine production
  4. incr NK cell activity
  5. incr phagocytic activity

are examples of ______

A
  1. incr immunoglobulin synthesis
  2. activation of T cells
  3. incr cytokine production
  4. incr NK cell activity
  5. incr phagocytic activity

are examples of the benefits of fever

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8
Q

What is the definition of FUO (Fever of Unknown Origin)
- 4 components

MEMORIZE AND KNOW THIS!!

A

definition of FUO (Fever of Unknown Origin)

  1. Fever > 38.3C
  2. illness lasting 3 wks
  3. NOT immunocompromised
  4. failure to reach dx w/ labs, XR
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9
Q

What is the MC etiology of FUO

A

MC etiology of FUO = Infections

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10
Q

Etiology of FUO: Infections

  • are most caused by microbes in the environment or by normal flora in our body
A

Etiology of FUO: Infections

-Infections mostly caused by normal flora in our body

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11
Q

Etiology of FUO

-what are the 4 other major classifications for the cause of FUPO>

A

Etiology of FUO

  1. Neoplasia
  2. Misc
  3. Connective Tissue D/o
  4. Undiagnosed
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12
Q

FUO workup

- what 3 tests are generalized/less invasive and a good place to start when working up FUO

A

FUO workup

  1. CBC w/diff
  2. CMP
  3. UA & culture
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13
Q

what is more common as the cause of FUO

  • uncommon dzs -OR-
  • uncommon manifestations of common dzs
A

Cause of FUO

  • Uncommon manifestations of COMMON DZs MORE COMMON than uncommon dz
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14
Q

FUO

- once the site of infection determined what should be done next

A

FUO

  • site of infection determined –> start empiric therapy
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15
Q

Etiology of FUO

-what is a common infectious cause of FUO

A

common infectious cause of FUO = TB!!!!

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16
Q

Tuberculosis

  1. what is the name of the species that causes this infection
  2. what is the hallmark of this dz
  3. how is this dz spread
A

Tuberculosis

  1. cause = mycobacterium tuberculosis
  2. hallmark = CASEATING granulomas
  3. spread is by respiratory droplets
17
Q

TB

  1. what 2 groups = incr risk of exposure to TB
  2. what 2 groups = incr risk of TB infxn
  3. what types of pts = incr risk of active TB once infected
    (gen and 1 spp example)
A

TB

  1. Incr risk of exposure to TB
    - close contacts of pts w/active TB + healthcare workers
  2. Incr risk of TB infxn
    - immigrants from high prev area, homeless
  3. Incr risk of active TB once infected
    - immunodeficient pts –> HIV+
18
Q

What cells in the body are responsible for the pathophysiology and granuloma formation seen in TB

A

alveolar macrophages

19
Q

What are the 3 outcomes of a TB infection

A

Outcomes of TB infection

  1. Primary TB
  2. Latent/Chronic TB
  3. Reactivation/2ndary TB
20
Q

3 Outcomes of TB infection

  1. what is the ONLY outcome where pts are NOT contagious
  2. which outcome is a/w apical cavitary lesions
  3. which outcome is characterized/controlled by granuloma formation and a (+) PPD
  4. which outcome is the result of the initial infection
A

3 Outcomes of TB infection

  1. ONLY outcome where pts are NOT contagious = LATENT/Chronic TB
  2. which outcome is a/w apical cavitary lesions
    - Reactivation/2ndary TB
  3. which outcome is characterized/controlled by granuloma formation and a (+) PPD
    - Latent/Chronic TB
  4. which outcome is the result of the initial infection
    - Primary TB
21
Q

3 Outcomes of TB infection: Reactivation/2ndary TB

  • what causes the reactivation of Latent TB
A

3 Outcomes of TB infection: Reactivation/2ndary TB

  • cause of reactivation of latent TB = waning of immune defense
22
Q

why is the formation of caseating granulomas (central necrosis, acidic, Low O2) imp in TB

A

creates a hostile enviro for MTB

23
Q

Pt presents w/ constitutional Sxs, chronic productive cough and pleuritic chest pain. On lung exam you note rales, consolidation and dullness in the middle R lobe.

Dx? (be specific)

A

Dx = Primary TB (middle/lower lobe consolidation)

24
Q

Extrapulmonary TB

  1. name of d/o that affects the vertebra
  2. name of the term for affecting the LNs
A

Extrapulmonary TB

  1. name of d/o that affects the vertebra = Pott’s Dz
  2. name of the term for affecting the LNs = scrofula
25
Q

If a pt has HIV and TB what do they have an incr risk of

A

HIV + TB = incr risk of reactivation TB

26
Q

Name of the test to screen for TB

A

PPD

27
Q

PPD: Screening for TB

  1. how long wait to see result?
  2. what is a positive result?
  3. what rxn size is considered (+) for HIV+, immunosuppressed, or close contact w/active TB pt
  4. what rxn size is considered (+) for pts w/no RFs for TB
A

PPD: Screening for TB

  1. wait 48-72hrs
  2. (+) result = transverse induration
  3. > 5 mm = (+) for HIV+, immunosuppressed, or close contact w/active TB pt
  4. > 15 mm = (+) for pts w/no RFs for TB
28
Q

What are the names of the 3 diagnostic studies used in suspected cases of ACTIVE TB

A

3 diagnostic studies used in suspected cases of Active TB

  1. Acid fast smear (bacilli) + sputum culture x 3 days
  2. CXR (PA + Lateral)
  3. Interferon Gamma Release Assay (Quantiferon)
29
Q

what is the gold std for dx TB

A

AFB (Acid Fast Bacilli) cultures

30
Q

What is the main indication of CXR for TB

A

to r/o active TB

31
Q

Patterns of TB seen on CXR

  1. what type of TB is a/w middle/lower lobe consolidation?
  2. what type of TB is a/w apical cavitary lesions?
  3. what type of TB is a/w diffuse, small nodular lesions?
A

Patterns of TB seen on CXR

  1. middle/lower lobe consolidation = Primary TB
  2. apical cavitary lesions = reactivation TB
  3. Diffuse, small nodular lesions = Miliary TB
32
Q

What is seen on CXR that indicates primary TB has healed

A

Granuloma on CXR indicates primary TB has healed

33
Q

Active TB Tx

  1. Names of drugs given?
  2. how long these 4 drugs given?
  3. how long is the TOTAL active TB tx?
  4. what 2 drugs given after the initial phase (continuation phase)
A

Active TB Tx

  1. Drugs = RIPE or RIPS
    - Rifampin, INH (+ Vit B6), Pyrazinamide, Ethambutol (or Streptomycin)
  2. given for 2 months
  3. total duration of active TB tx = 6 mos
  4. Continuation phase drugs = RI
    - Rifampin + INH (+ Vit B6)
34
Q

PPx of TB - when should ppx be started

A

PPx of TB

indicated when exposure to TB and (-) CXR

35
Q

Latent TB and PPx TB Tx

  1. what 2 things given in both situations
  2. how does the length of Tx differ if pt is HIV+
  3. what is the minimum ppx duration needed
A

Latent TB and PPx TB Tx

  1. INH + Vit B6
  2. HIV+ –> longer tx
  3. need ppx for at least 2 wks

Infectious Diseases (9 decks)

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