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Phase 4 > Pyrexia of unknown origin > Flashcards

Pyrexia of unknown origin Flashcards

1
Q

What temperature is considered a fever?

A

> 38.3C

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2
Q

What are the clinical stages of fever?

A

Chill
Fever
Flush

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3
Q

What is a pyrexia of unknown origin?

A

Temperature >38.3.
Initially more than 3 weeks duration of illness.
Failure to reach a diagnosis despite 3 days of inpatient investigation.
Nocosomial pyrexia
Immunodeficient PUO
HIV-associated PUO

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4
Q

What are the aetiologies of fever?

A 
Infection
Malignancy
Drugs
Connective tissue disease
Endocrine
Other
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5
Q

Which region determines temperature?

A

Organum vasculosum of lamina terminalis (OVLT) in anterior hypothalamus

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6
Q

What are the endogenous pyrogens?

A

IL-6

TNF-alpha

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7
Q

What are exogenous pyrogens?

A

Micro-organisms, LPS

Stimulate cytokines or act directly on OVLT

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8
Q

What causes fever post brain injury?

A 
Thermal dysregulation.
Shift to anaerobic metabolism and reperfusion injury - thermogenesis. 
Cerebral production of cytokines.
Cell death
Excitotoxicity
Blood and degradation products - heat
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9
Q

Give some endocrine causes of fever.

A

Hyperthyroidism: increased peripheral tissue metabolism, resetting of hypothalamus thermostat.
Phaeochromocytoma: necrosis, metabolite excretion .
Adrenal insufficiency: AI, malignancy, infectious process

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10
Q

What are the complications of infective endocarditis?

A

Septic embolisation
Cardiac - valvular insufficiency, heart failure, peri-valvular abscess, intracardiac fistula, pericarditis
Neurological - brain abscess, stroke
Systemic immune reaction
Metastatic infectoin - psoas abscess, vertebral osteomyeltitis, septic arthritis.

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11
Q

What are the differential diagnosis of infective endocarditis?

A

Bacteraemia without valvular vegetation: sepsis, PVC/CVC infection, Deep-seated infections
Valvular vegetation without bacteraemia:
atrial myxoma, vasculitis, acute rheumatic fever, antiphospholipid syndrome

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12
Q

What are the investigations for endocarditis?

A

Blood cultures: 3 sets, one hour apart.
Urinalysis
ECG - new/evolving conduction disease, ischaemia
Transthoracic echo initially, transoesophageal echo- high sensitivity//specificity

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13
Q

What is the major Duke’s criteria?

A

Positive blood cultures:
2 positive blood cultures with typical organisms
Persistent bacteraemia from 2 blood cultures more than 12 hours apart, or 3 blood cultures with less specific organisms
Positive serology for coxiella burnetti, barrtonella species, or chlamydia psittaci

Endocardial involvement:
Echo: vegetation, abscess, new partial dehiscence of prosthetic valve
Positive molecular assays for specific gene targets

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14
Q

What are the minor duke’s criteria?

A

Predisposing heart disease/IVDU
Fever >38
Immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots, or positive rheumatoid factor
Microbiological evidence not fitting major criteria
Elevated CRP or ESR
Vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, petechiae, or purpura

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15
Q

How many Duke’s criteria need to be filled to diagnose endocarditis?

A

Pathological criteria positive OR
Two major criteria OR
One major and two minor criteria OR
Five minor criteria

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16
Q

What is the management of endocarditis?

A

Antibiotics by organism and sensitivty - if clinically stable hold off until known
If clinically unwell - empmirical antibiotics
Repeat blood cultures
4-6 weeks of antibiotics usually
Monitor renal function

17
Q

What are the indications for surgery in endocarditis?

A

Failure of medical management
Acute left heart failure
Recurrent systemic emoblic episodes
Pathogens resistant to current antibiotics
>1cm mitral leaflet vegitation
Prosthetic valve involvement with non-strep

18
Q

What are the complications of hepatitis A?

A

Cholestatic hepatitis
Relapsing hepatitis
Autoimmuen hepatitis

19
Q

What are the features of neuroleptic malignant syndrome?

A 
Fever
Muscular rigidity
Elevated CK
Tachycardia
Labile BP
Tachypnoea
Sweating
Altered GCS
Elevated WCC
20
Q

What does neuroleptic malignant syndrome occur in association with?

A

Dopamine antagonists

21
Q

What are the features of serotonin syndrome?

A 
Mental status change
Agitation
Myoclonus
Hyperreflexia
Sweating
Shivering
Tremor
Diarrhoea
Incoordination
Fever

Phase 4 (12 decks)

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