Respiratory- Common PC Fever/rigors/night-sweats

Question 1

Causes of fever/rigors/night sweats

Answer 1

• infection (acute or chronic) is the usual cause but can be caused by
• lung cancer
• lymphoma
  -vasculitis

Question 2

Fever, Rigors and night sweats what the symptoms mean

Answer 2

• Patients use many different terms to describe fever (e.g.,shivers, chills, shakes). so take care to clarify their actual symptoms
• Rigors are generalised, uncontrollable episodes of vigorousbody shaking lasting a few minutes.
• Despite high fever,the pa-tient may complain of feeling cold and seek extra clothing.
• Rigors usually indicates bacterial sepsis;lobar pneumonia and acutepyelonephritis are the most common causes.
• Night sweats,particularly if persistent,are associated with chronic infection such as TB or malignancy, particularly lymphoma.
• Occasional episodes are inconclusive, but if patients report having to change their nightclothes or sheets frequently due to profuse nocturnal sweating over several weeks, thissuggests underlying disease.

Question 3

Weight loss

Answer 3

• Weight loss is a common feature of respiratory diseases, including lung cancer, COPD, interstitial lung disease, and chronic infections such as tuberculosis and bronchiectais.
• breathlessness is associated with diminished appetite,and the systemic inflammatory response is also thought to contribute to weight loss.
• Weight loss also occurs in acute infection with loss of appetite, particularly during hospitalisation.
• Ask the patient to estimate the extent and duration of weight loss and enquire about appetite and dietary intake.

Question 4

Sleepiness- what can it mean
Hint OSA/OSASH

Answer 4

• Excessive daytime sleepiness may be a symptom of an underlying sleep-related breathing disorder-obstructive sleep apnoea (OSA) or OSA/sleep hypopnoea(OSASH).
• In these conditions, the upper airway collapses intermittently and repeatedly during sleep.
• Partial obstruction results in snoring,but complete collapse stimulates increased respiratory effort resulting in transient wakening.
• Repeated episodes of sleep disturbance cause excessive daytime sleepiness and poor concentration.
• OSASH is more common in men;particularly if obese and with a large neck(collar sizes>17 inches) and can be aggravated by alcohol.

Question 5

Sleepiness- what to ask about

Answer 5

• Normal sleeping habit I.e normal sleeping hours
• Shift or night work
• Does the person wake refreshed or exhausted
• Sleep apnoea patients are exhausted in the morning.
• Have they struggled to stay awake in the day: for example, at work or when driving?

Question 6

OSA

Answer 6

• It is vital to advise cessation of driving pending investigation if OSA is suspected.
• ideally seek a description of any night-time breathing disturbance from a bed partner.
• In OSA, the partner may observe periodic cessation of breathing, accompanied by increasing respiratory efforts
• can use validated daytime sleepiness scores (Epworth sleepiness)