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Infectious Diseases > T13: Pyrexia of unknown origin > Flashcards

T13: Pyrexia of unknown origin Flashcards

1
Q

What is the normal temperature in a healthy 18-40-year-old?

A

36.8 +/- 0.4 degrees Celsius

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2
Q

List 3 causes of physiological elevations in body temperature

A
  1. postprandial
  2. pregnancy
  3. Menstruation
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3
Q

List 4 ways through which we measure temperature

A
  1. Oral
  2. Rectal
  3. Axillary
  4. Tympanic membrane
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4
Q

The least reliable way of measuring temperature

A

Axillary

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5
Q

The most commonly used but less reliable in respiratory diseases way to measure temperature

A

Oral

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6
Q

How does rectal temperature differ from oral temperature?

A

It is > 0.4 degrees Celsius

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7
Q

How does the tympanic membrane method work and how does it differ from the oral method?

A

It measures heat radiation from the tympanic membrane. It is more variable than oral.

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8
Q

PHYSIOLOGY OF THERMREGULATION: There is an ongoing balance between heat loss and production. List 4 ways through which heat is produced

A
  1. Oxidation of nutrients
  2. Cellular metabolism
  3. Blood circulation
  4. Involuntary contraction of muscles
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9
Q

PHYSIOLOGY OF THERMREGULATION: There is an ongoing balance between heat loss and production. List 4 homeostatic mechanisms of heat regulation (excluding hypothalamic thermoregulation center)

A

Autonomic- sympathetic nerves
Endocrine- adrenal, thyroid, sweat gland
Metabolic- skin arterioles
Behavioral - take clothes on/ off (skeletal muscles- voluntary)

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10
Q

Name the 3 endocrine organs involved in thermoregulation

A
  1. Thyroid.
  2. Adrenal
  3. Sweat glands
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11
Q

State whether this refers to fever or hyperthermia:

- Setpoint remains unchanged

A

Hyperthermia

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12
Q

State whether this refers to fever or hyperthermia:

- Caused by: Neuroleptic malignant syndrome, Malignant hyperthermia, and serotonergic syndrome

A

Hyperthermia

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13
Q

State whether this refers to fever or hyperthermia:

- Pathogenesis: Heat conservation and thermogenesis

A

Fever

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14
Q

State whether this refers to fever or hyperthermia:

- Caused by infection, inflammation, cancer, medications, Thrombosis

A

Fever

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15
Q

State whether this refers to fever or hyperthermia:

Pathogenesis: Exogenous heat exposure or endogenous heat protection (can rapidly become fatal)

A

Hyperthermia

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16
Q

PATHOGENESIS OF FEVER: State whether the following refers to endogenous or exogenous pyrogens:

Derived from bacteria, viruses, parasites, fungi&raquo_space; stimulate other pyrogens via immune activation

A

Exogenous pathogens

17
Q

PATHOGENESIS OF FEVER: State whether the following refers to endogenous or exogenous pyrogens:
Pyrogenic cytokines: IL-1, IL-6, TNF, IFN-y, monocytes, lymphocytes, neutrophils. Stimulated by: inflammation, tissue necrosis, immune complexes

A

Endogenous pyrogens

18
Q

CONSEQUENCES OF FEVER:

At which temperature (rectal) do you get permanent brain damage?

A

> 41 degrees Celcius

19
Q

CONSEQUENCES OF FEVER:

Up to which temperature can you be spared from thermal injury?

A

41 degrees Celcius

20
Q

CONSEQUENCES OF FEVER:

At which temperature can you get: heat stroke and death

A

> 43 degrees Celcius

21
Q

We use the Durack and Street classification for Fever of Unknown Origin (FUO). List the 4 categories we look at

A
  1. Classical FUO
  2. Nosocomial FUO
  3. immune-deficient FUO
  4. HIV-related FUO
22
Q

Immunodeficient FUO is:

  1. Also called?
  2. Sources?
  3. 4 Causative Organisms
  4. Management?
A
  • Neutropenic FUO
  • Focal bacterial/ fungal bacteraemia/ catheter-related/ perianal
  • S.aureus, TB, Gram negatives, HSV, CMV,fungal
  • Broad spectrum A/B
23
Q

True or false:

More than 50% of nosocomial FUO is non-infectious and ~ 25% is infectious

A

false

24
Q

Which 7 groups of patients are at risk of Nosocomial infectious FUO?

A
  1. Original surgical field
  2. U-catheter
  3. Intubated
  4. Diarrhoea
  5. IV lines
  6. Prostheses
  7. Source control
25
Q

What are some non-infectious causes of nosocomial FUO? (8)

A
  1. 24 hours post-op
  2. DVT
  3. MI
  4. Drug fever
  5. Transfusion reaction
  6. Neoplasm
  7. Drug/ ETOH withdrawal
  8. Acalculous cholecystitis
26
Q

Classical FUO has 4 categories (nature of pathology) with a mnemonic: INCUM. Name these

A 
Infection
Neoplasm
Collagen vascular disease
Undiagnosed
Miscellaneous
27
Q

Account, in 4 ways, for the changing epidemiology of classical FUO

A
  1. Ubiquitous use of A/B
  2. Imaging
  3. Tests: immunological, tumour antigen assays
  4. Increased detection of rheumatologic diseases
28
Q

Rheumatological causes of classical FUO: List the causes in the following groups of patients:

  1. Young patients
  2. Old patients
A
  1. Still’s disease, SLE

2. Temporal arteritis, polymyalgia rheumatica

29
Q

The modifying factors of classical FUO are age- and geographic location-related. explain.

A

Elderly= more neoplastic or multisystem disease causes
Young= most no case identified (good prognosis, less likely underlying disease)
LMI countries= more infections, HIC= more evenly distributed causes

30
Q

Explain, in 3 steps, your approach to FUO

A

Step 1: History, Physical exam, non-specific tests
Step 2: More detailed Ix (decide on which organ/ system is involved)
Step 3: Definitive Ix to confirm Dx

31
Q

True or false

Fever patterns are of great help in the diagnosis of FUO conditions

A

False

32
Q

Diagnose this patient:

  • Patient looks well
  • Temperature normal under supervision
  • Bizzare temperature chart > 41 with no diurnal variations and no correlation between pulse rate and temperature
  • No sweating when fever resolves
  • Evidence of self harm, injection
  • Normal ESR/CRP
A

Factitious fever

Infectious Diseases (8 decks)

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