Approach to Fever

Question 1

What is a normal temperature?

Answer 1

98.2 + or - 0.7

Question 2

What is the daily variation that occurs with fever?

Answer 2

Nadir at 0600, and peak at 1700

Question 3

How much higher is rectal temp compared to oral?

Answer 3

Usually 1 degree F higher

Question 4

What is the effect of menstruation on body temp?

Answer 4

Increases by a degree C

Question 5

What is the definition of a fever?

Answer 5

Two consecutive elevations of 101 F, unless neutropenic (then just one)

Question 6

What is the thermoregulatory center of the body?

Answer 6

Hypothalamus

Question 7

What is the cooling center of the body?

Answer 7

Anterior hypothalamus

Question 8

What is the heating center of the body?

Answer 8

Posterior hypothalamus

Question 9

Where are our thermoreceptors?

Answer 9

Skin and muscles

Question 10

What is the definition of hyperthermia?

Answer 10

Increased body temp above that set by the central regulation due to insufficient heat dissipation

Question 11

What are the two main exogenous sources of pyrogens?

Answer 11

Toxins

Microorganisms

Question 12

What are the major cytokines that mediate fever?

Answer 12

IL-1, IL-6, IFN, TNF

Question 13

What is the definition of a fever of unknown origin (FUO)?

Answer 13

Fever greater than 38.3 for 2 or 3 weeks without identifiable etiology

Question 14

What is a fever without localizing source?

Answer 14

Fever without ssx or a localizing source

Question 15

What is the most common cause of fever without a localizing source?

Answer 15

Infectious etiology

Question 16

What is the most common cause of fever without a source in 3-36 mo?

Answer 16

Occult bacteremia w/o ssx of sepsis

Question 17

What are the predictors of occult bacteremia?

Answer 17

• Fever

- WBC more than 15K

Question 18

What is NOT predictive of occult bacteremia?

Answer 18

Response to antipyretics

Clinical appearance

Question 19

What percent of kids with a fever w/o source and a white count of greater than 30k have occult bacteremia?

Answer 19

42.3%

Question 20

True or false: vaccines can mask ssx

Answer 20

True

Question 21

What is the Yale observational scale?

Answer 21

Assessment to quantify toxic appearance, with higher score meaning more toxic

Question 22

What is the most common cause of osteomyelitis in sickle cell patients?

Answer 22

Salmonella

Question 23

What is the sensitivity and specificity of a WBC count greater than 15k for sepsis?

Answer 23

80% sensitive and specific

Question 24

True or false: patient with Neisseria meningitides always have leukocytosis?

Answer 24

False– may have leukopenia

Question 25

When are blood cultures particularly warranted?

Answer 25

If WBC more than 15k

Question 26

When are urine cultures necessary?

Answer 26

If there is an abnormal UA

Question 27

What are the labs that are helpful in the diagnosis of sepsis in infants?

Answer 27

CRP | Procalcitonin

Question 28

What diseases can result in aberrant CRP and procalcitonin levels?

Answer 28

Renal disease

Question 29

What are the four bacteria that should be suspected of causing sepsis?

Answer 29

S. pneumo S. Aureus Neisseria Hemophilus

Question 30

What is the abx of choice for sepsis?

Answer 30

Ceftriaxone

Question 31

What is the most common cause of a fever without a source in adults? How is this different than in children?

Answer 31

Infections still most common as in adults, but non-infectious causes increase

Question 32

What are the four organ systems that should be suspected of causing bacteremia?

Answer 32

Lung Urinary Abdomen Endocarditis

Question 33

What are the four categories of FUOs?

Answer 33

Nosocomial Neutropenic HIV-associated Classic

Question 34

What specific patient population needed to be treated for sepsis urgently?

Answer 34

HIV associated or immunocompromised

Question 35

What is the most common nosocomial sepsis?

Answer 35

Pneumonia | UTIs

Question 36

What are the inflammatory causes of sepsis?

Answer 36

Aspiration Phlebitis Arthritis

Question 37

What percent of nosocomial fevers are caused by malignancy?

Answer 37

10%

Question 38

What percent of fevers are caused by ischemia (MI, stroke, PE etc)?

Answer 38

6%

Question 39

What percent of nosocomial fevers are caused by drugs?

Answer 39

10%

Question 40

How can you diagnose fevers caused by drugs?

Answer 40

Monitor fevers spikes and if they occur with drug administration

Question 41

What percent of FUOs are: infectious?

Answer 41

30%

Question 42

What percent of FUOs are: malignancy?

Answer 42

30%

Question 43

What percent of FUOs are: inflammatory/autoimmune?

Answer 43

10%

Question 44

What percent of FUOs are: undiagnosed?

Answer 44

10%

Question 45

What is the most common infectious cause of FUO?

Answer 45

Abdominal abscesses

Question 46

What should be infectious cause of FUO should be suspected in DM pts?

Answer 46

Osteomyelitis

Question 47

What are the two most common malignancies that cause fevers?

Answer 47

Hodgkin's disease Non-Hodgkin's Leukemia

Question 48

What causes fever of malignancy?

Answer 48

Release of cytokines

Question 49

What is Still's disease?

Answer 49

a rare systemic inflammatory disease characterized by the classic triad of persistent high spiking fevers, joint pain and a distinctive salmon-colored bumpy rash Unknown cause

Question 50

What are the autoimmune diseases that can cause FUOs?

Answer 50

SLE Still's disease Polymyalgia rheumatic

Question 51

What are the three most common autoimmune causes of FUOs?

Answer 51

- Granulomatous hepatitis - Crohn's - Sarcoidosis

Question 52

What is Sutton's law?

Answer 52

First, consider the obvious

Question 53

What is the classic cause of IL-12 resistance?

Answer 53

BCG vaccine

Question 54

What is temporal arteritis?

Answer 54

Vasculitis of the branches of the external carotid artery, which may affect the ophthalmic artery