Fever/Antimicrobial Resistance

Question 1

what degree is the “temp” of a fever?

Answer 1

> 101 or 38.3 degrees Celsius (some people say 100.4 or 100.8)

Question 2

what is normal body temp? how many times does it peak during the day?

Answer 2

97-99.5 (36.0-37.4); peaks twice diurnally

Question 3

what is hyperthermia?*

Answer 3

conditions or drugs that induce a BREAKDOWN of thermoregulatory systems, which results in elevated body temp

Question 4

what is a fever?*

Answer 4

conditions that change the HYPOTHALAMIC SET POINT so that thermoregulatory systems create a higher body temp

Question 5

fever pathophys: when __________ and __________ are stimulated by invading organisms, they put out ___________ ___________ that cause elevation in basal ______ __________

Answer 5

monocyte and macrophages; pyrogenic cytokines; body temperature

Question 6

cytokines that affect ________ can be produced in ___________ situations: fever _____ _______ always = infection

Answer 6

temperature; noninfectious; does not

Question 7

does degree of fever elevation correlate with severity of illness?

Answer 7

NO

Question 8

children tend to have ________ fevers, compared to elderly who may ______ get a fever

Answer 8

higher; not

Question 9

what type of medications may reduce febrile response?

Answer 9

anti-cytokine (esp interleukins)

Question 10

what happens if fever is over 106?

Answer 10

can get irreversible brain damage

Question 11

when should you treat a fever? what is the tx?

Answer 11

treat if over 104; antipyretics most helpful (acetaminophen or aspirin)
2nd line: warm water baths, ice packs

Question 12

when would you treat fever at a lower temp (less than 104)?

Answer 12

to improve comfort or if pt is hemodynamically unstable (temp inc HR)

Question 13

how to define a classic fever of unknown origin

Answer 13

adults: an illness lasting more than 3 weeks with temps greater than 101
* dx has not been made despite a good eval (3 hospital days or 3 outpatient visits)

Question 14

a diagnosis eventually can be made in ______- _____% of FUO cases

Answer 14

70-90%

Question 15

how to define a nosocomial FUO

Answer 15

fever greater than 101 on multiple occasions in hospitalized pt; infection not incubating on admission; uncertain dx after 3 day eval (including 2 day culture incubation)

Question 16

definition of neutropenic FUO

Answer 16

Fever ≥38.3°C (101°F) on multiple occasions
Absolute neutrophil count <500/μL
Uncertain diagnosis after 3-day evaluation, including 2-day microbiologic culture incubation

Question 17

definition of HIV associated FUO

Answer 17

Fever ≥38.3°C (101°F) on multiple occasions
Confirmed diagnosis of HIV infection
Fever >1mo (outpatients) or >3 days (inpatients)
Uncertain diagnosis after 3-day evaluation, including 2-day microbiologic culture incubation

Question 18

what is the most common cause of FUO?

Answer 18

infections (1/3)

Question 19

what is the most common systemic bacterial cause of FUO?

Answer 19

TB

Question 20

besides infections, what also causes 1/3 of FUOs? what accounts for 20% of cases? what % of FUOs remain undiagnosed?

Answer 20

neoplasms; Rheumatologic diseases account for 20%; 10% remain undiagnosed

Question 21

which patients usually get neutropenic fever?

Answer 21

pts on cytotoxic chemotherapy tx

Question 22

neutropenic fever: with absolute neutrophils <1000/ul, pts are at ___ ____ for infection, but _______ if below 500/ul

Answer 22

high risk; critical

Question 23

HIV patients who have a FUO are usually infected with….

Answer 23

MAC- mycobacterium avium complex

Question 24

usual cause of elderly patients’ FUO

Answer 24

UTI

Question 25

hospitalized pts’ FUO are usually from….

Answer 25

central line infections

Question 26

fever in a neutropenic patient should be considered ________

Answer 26

URGENT: give broad spectrum ABX

Question 27

do dental abscesses always cause fevers?

Answer 27

no

Question 28

what do you NOT give to someone to tx FUO?

Answer 28

steroids

Question 29

PEARL: evidence for ______ from reducing fever is _________

Answer 29

benefit; limited

Question 30

who causes ABX resistance?

Answer 30

humans

Question 31

3 mechanisms of ABX resistance

Answer 31

1) . enzyme degradation (beta lactamase)
2) . structural modifications
3) . drug “pumps” remove drug from cells (multidrug resistance)

Question 32

presence of cough for suspected strep pharyngitis is _____ strep

Answer 32

NOT

Question 33

rapid strep test is _____% sensitive: if positive, _____ pt. if negative, ________

Answer 33

90%; pos- treat, neg- culture

Question 34

most bronchitis is _______; even _________ will resolve in most cases

Answer 34

viral; bacterial (may tx if pt is toxic)

Question 35

what is first choice for tx of AECB and pertussis?

Answer 35

macrolides (mycins)

Question 36

how to tx drug resistant S pneumo (DRSP)

Answer 36

needs higher PCN levels (augmentin XR, with 2 g BID amoxicillin)

Question 37

what test might aid in whether or not to tx a suspected S pneumo infection?

Answer 37

urine antigen test

Question 38

what disease do you suspect for cellulitis/abscess that doesn’t respond to Keflex or dicloxacillin?

Answer 38

community acquired MRSA

Question 39

MRSA pneumonia is associated with ________

Answer 39

influenza

Question 40

what drug do you NOT use first line for community acquired MRSA? what IS first line?

Answer 40

vancomycin; Bactrim (minimal resistance)

Question 41

vancomycin-resistant enterococcus is what type of bug?

Answer 41

hospital/healthcare associated bug

Question 42

what two antivirals does the CDC no longer recommend to tx influenza A? which two SHOULD be used now?

Answer 42

amantadine and rimantadine (zanamivir or oseltamivir should be used)

Question 43

what is now the tx of UTI (uncomplicated cystitis)

Answer 43

nitrofurantoin, Bactrim, or fosfomycin are preferred (NO longer cipro)

Question 44

first line tx of C diff

Answer 44

oral vancomycin (or fidaxomicin or rifaximin)

Question 45

goal of ABX prescribing

Answer 45

use the narrowest spectrum ABX possible

Question 46

what is the most important tx step before giving ABX?

Answer 46

drainage of abscesses

Question 47

how to tx bronchitis?

Answer 47

since most viral- symptomatic

-bronchodilators, maybe cough suppression