Pyrexia

Question 1

What is an intermittent fever?

Answer 1

Where the temperature returns to normal at least once every 24 hours

Question 2

What kind of fever remains above normal with only minimal variations?

Answer 2

Sustained or continuous fever

Question 3

What is a remittent fever?

Answer 3

Where the temperature does not return to normal and varies a few degrees in either direction

Question 4

What is a recurring/relapsing fever?

Answer 4

Where there is one or more episodes of fever lasting as long as several days with one or more days of normal temperature

Question 5

What is the central regulator of core body temperature?

Answer 5

Heat sensitive receptors located in the pre-optic area of the anterior hypothalamus

Question 6

How many stages of fever are there?

Name them.

Answer 6

4

1. Prodromal stage
2. Chill stage
3. Flush stage
4. Defervescence stage

Question 7

What occurs in the first stage of fever?

Answer 7

Non specific complaints such as headache, fatigue, general malaise, and aching

Question 8

How does the nervous system control body temperature?

Answer 8

With elevations in core temperature the sympathetic nervous system is inhibited and when body temperature is below thermal set point the sympathetic nervous system is activated

Question 9

How does the sympathetic nervous system increase body temperature?

Answer 9

Vasoconstriction of skin blood vessels and activation of the shivering centre and inhibition of sweating together with endocrine and behavioural responses to promote heat production

Question 10

What occurs during the third stage of fever?

Answer 10

Cutaneous vasodilation occurs and the skin becomes warm and flushed leading to the last phase

Question 11

What occurs during the last stage of fever?

Answer 11

Febrile response marked by the initiation of sweating

Question 12

What should be the first step in managing fever?

Answer 12

Actively searching for the cause of the fever

Reassure that the fever is beneficial

Question 13

Name some pyrogenic cytokines.

Answer 13

Pro-inflammatory cytokines:
IL-1
IL-6
TNF-alpha
Interferon

Question 14

What modifies the responsiveness of thermosensitive neurone in illness?

Answer 14

Release of prostaglandin E2 caused by cytokine-receptor interactions in the pre-optic region of the anterior hypothalamus

Question 15

What drugs inhibit the release of PGE2 and reduce fever?

Answer 15

NSAIDs
Aspirin
(both antipyretics)

Question 16

What is CRP and what does it do?

Answer 16

C-reactive protein

Released by liver and promotes the immune system to destroy and inhibit microbial organisms

Question 17

What can uncontrolled fever in young children cause?

Answer 17

Febrile seizures

Question 18

Apart from fever what else can cause high temperature?

Answer 18

Hyperthermia
Drug-induced fever
Malignant hyperthermia
Neuroleptic malignant hyperthermia

Question 19

What is hyperthermia?

Answer 19

High temperature not caused by pyrogens

A pathological increase in body temperature without change in set point of the hypothalamic regulatory centre

Question 20

How should you manage hyperthermia?

Answer 20

Physical cooling

Question 21

What drugs can induce fever?

Answer 21

Antihistamines
Tricyclic antidepressants
Cimetidine
Anticancer drugs

Question 22

How do antihistamines and TCAs induce fever?

Answer 22

Impair heat dissipation

Question 23

How does cimetidine induce fever?

Answer 23

Directly blocking receptors in the hypothalamus

Question 24

How do anticancer drugs induce fever?

Answer 24

As a direct pyrogen

Question 25

What is the best method of measuring temperature? (for both patient comfort and accuracy)

Answer 25

Tympanic temperature

Question 26

What is the most accurate method of measuring temperature?

Answer 26

Rectally

Question 27

What type of protein is CRP?

Answer 27

Acute phase protein (APP)

Question 28

Name an endogenous antipyretic factor.

Answer 28

IL-10