E2- FEVER!

Question 1

What can each of these cause? Inflammation, Cancers, AutoImmune Disease, Exercise, and High Environment, Stroke, Heart Attack…

Answer 1

Each can cause a FEVER

Question 2

What are the two classifications for fever due to infection?

Answer 2

local (abscess), or systemic (sepsis)

Question 3

What was Acute Bacterial Endocarditis (ABE) and example of?

Answer 3

Systemic Infection

Question 4

ASIDE: What is the bacterium to consider when doing an extraction?

Answer 4

Streptococcus Viridans

Question 5

What are these examples of? Acute Leukemias, both Myelogenous and Lymphoblastic.
Hodgkins and Non-Hodgkins Lymphoma
Renal Cell Carcinomas and Hepatocellular Carcinomas
Primary Brain Tumors that effect temperature regulation in the Hypothalamus

Answer 5

Fever Causing Neoplasms

Question 6

What are the two classifications of systemic inflammatory diseases that cause fever?

Answer 6

AUTOIMMUNE (Lupus, Rheumatoid Arthritis, PAN) & GRANULOMATOUS (Sarcoidosis, Crohn’s Disease, Giant Cell-temporal-Arteritis)

Question 7

What are 4 COMMON drugs that cause fever? (3 neuro drugs)

Answer 7

1.Antihistamines 2.AntiPsychotics 3.Tricyclic Antidepressants 4.Monoamine Oxidase Inhibitors (MAOI)n

Question 8

What ILLICIT drugs cause fever?

Answer 8

Cocaine, PCP, Meth, LSD

Question 9

What is the genetic disorder that causes fever after administration of anesthetic?

Answer 9

Malignant HyperThermia (OS example, what Saro wrote his thesis on)

Question 10

What is the fever caused by an adverse reaction to neuroleptic/anti-psychotic drugs?

Answer 10

Neuroleptic Malignant Syndrome

Question 11

What is the fever induced by the endocrine glands we recently discussed?

Answer 11

Hyperthyroidism and Pheo-chromo-cytoma(tumor in adrenal medulla)

Question 12

BOARD Q: When looking at a FUO (fever unknown origin), Which three systems will you concentrate on (they are the most common)?

Answer 12

80% of infections: 1.Respiratory 2. Urinary 3.Skin/Soft Tissue (THE MAIN ENTRY POINTS TO THE CASTLE!)

Question 13

What area of the brain regulates temperature? HOW?!

Answer 13

The Hypothalamus. VasoDilation and Sweating

Question 14

What is the body temperature threshold for a fever diagnosis?

Answer 14

37 C (98.6 F)

Question 15

What is the fever causing substance associated with fever caused by infection?

Answer 15

an Endogenous pyrogen

Question 16

What is a pyrogen? Please don’t get this wrong..

Answer 16

Anything that causes a fever :)

Question 17

What are the Gram - pyrogens?

Answer 17

Endotoxins..aka…LipoPolySaccaride

Question 18

What are the Gram + pyrogens?

Answer 18

Enterotoxin

Question 19

What two things do pyrogens stimulate to cause fever?

Answer 19

The hypothalamus and Cytokines

Question 20

What are the 4 cytokines mainly involved in fever?

Answer 20

InterLeukins 1,2,&6, Tumor Necrosis Factor

Question 21

What are the 3 SENTINEL immune cells (the Watchmen)? What do they recognize? WHAT IS THE OFFICIAL NAME?

Answer 21

1. Macrophages 3. Mast Cells 4. Dendritic Cells—they recognize structural molecules on microbes (like LPS)…OFFICIAL name: “Toll-Like Receptors”

Question 22

Who makes the cytokines? What do they do?

Answer 22

The TLR’s (toll-like receptors) make the cytokine and it signals other cells to come and eat.

Question 23

What do Interleukins 1 and 2 (IL-1,2) along with TNF (Tumor Necrosis Factor stimulate in the hypothalamus?

Answer 23

The IF-1, IF-2, and TNF stimulate Prostaglandin (PGE-2) synthesis from the hypothalamic thermoregulatory center.

Question 24

How does Aspirin BLOCK fever?

Answer 24

Inhibits IL-1 from stimulating Prostaglandin synthesis in the hypothalamus

Question 25

What is the most common cause of death in ICUs?

Answer 25

Septic/Endotoxic Shock from Gram - (G+ and Fungus can also cause sepsis)

Question 26

What do all of these have in common? gram-negative bacteria such as E.coli, Proteus, Serratia, Pseudomonas, K. pneumoniae, and the anaerobe Bacteroides..

Answer 26

they all cause septic shock with their endotoxins

Question 27

What is the complex that binds to Toll-Like Receptors on WBCs causing the release of inflammatory markers?

Answer 27

LPS + LPS binding protein

Question 28

ASIDE: What does CD stand for in CD4, CD8, CD14?

Answer 28

Cluster Designation

Question 29

Is there a link between cancer and fever?

Answer 29

Possibly, some tumors thought to release pyrogens

Question 30

What are the three possible causes for the very rare hypothalamic fever?

Answer 30

head trauma, hemorrhage, or a tumor

Question 31

What is the source for the extremely rare malignant hyperthermia? Is it genetic?

Answer 31

yes, autosomal dominant...sarcoplasmic reticulum causes a rapid release of Ca2+

Question 32

What are the two anesthetics causing malignant hyperthermia?

Answer 32

Halothane and Succinylcholine

Question 33

Going back to Neuroleptic Malignant syndrome...what is the cause?

Answer 33

inhibition of central dopamine receptors in the hypothalamus

Question 34

What is the neutrophil count that signals acute inflammation?

Answer 34

An increase of 10,000 WBCs/mm3 ---> to 12,000/15,000 WBCs/mm3