EXAM #1: APPROACH TO FEVER Flashcards Preview

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Flashcards in EXAM #1: APPROACH TO FEVER Deck (20):
1

What is the definition of a fever?

Core temperature of 38.0 degrees C or 100.4 F

2

In the neutropenic patient, what is a fever?

Core temperature of 38.0 degrees C or 100.4 F for an HOUR

or

SINGLE oral temperature of 38.3 C/ 101.0 F

3

What causes a fever?

- Altered hypothalamic set point to a higher temperature
- Endogenous/ exogenous PYROGENS lead to the change in set point

4

What is central fever?

Lesion of the hypothalamus causing fever

5

What are the major exogenous pyrogens?

1) Toxins
2) Microorganisms

6

What are the major endogenous pyrogenic cytokines (4)?

IL-1B
IL-1a
TNFa
IL-6

7

What is a fever without a localizing source? What patient population is this more common in?

Patient with fever but no without focal signs of infection e.g.
- Self-limited viral
- Self-limited or occult bacterial

8

What is the definition of fever of unknown origin?

Fever greater than 38.3 C that:
- Lasts 2-3 weeks
- Occurs on multiple visits
- Unable to id. despite work-up

9

What would lead to suspect occult bacteremia in a patient with fever without source?

Age 3-36 months
1) Fever grater than 39 C
2) WBC greater than 15K

*Note that response to antipyretics and clinical appearance are NOT good predictors of the absence of occult bacteremia

10

What is the utility of the Yale Observational scale?

Quantification of "toxic appearance"

*The higher the score, the more likely the presence of occult bacteremia

11

When are parenteral antibiotics indicated for a 3-36 months with fever without source?

1) Ill appearing
2) Unstable
3) Abnormal lab findings
4) Un-immunized

12

What abx should be given for kids between 3-36 months with fever without source?

Ceftriaxone

13

What bacteria are you targeting with Ceftriaxone in a child with fever without source?

S. pneumoniae
S. aureus
N. meningititis
H. influenza

14

How does fever without source differ in adults compared to kids?

More likely to be a noninfectious source

15

What are the four major types of fever with an unknown origin?

1) Nosocomial
2) Neurtropenic
3) HIV-associated
4) Classic

16

What is the most common cause of nosocomial fever?

Nosocomial infection

17

What are the most common causes of classic fever of unknown origin?

Infection and malignancy are tied (30% each)

18

In infectious causes of fever of unknown origin, what is the most common cause of fever?

Abdominal abscess (esp. if the patient had sustained trauma)

19

What is the most common malignancy to cause FUO?

Lymphoma (Hodgkin's and Non-Hodgkin's)

20

What is an Pel-Ebstein fever?

Patient experiences fevers which cyclically increase then decrease over an average period of one or two weeks

*Associated with Lymphoma