Fatigue + Fever Flashcards
Causes of fatigue by system
Cardioresp: CHF, COPD, OSA
Endocrine: DM, hypothyroidism, Addisons
GI: celiac, chronic liver dz, biliary cirrhosis, malignancy
Haem: anemia, autoimmune, hemochromatosis, lymphoma, leukamia
Infection: HIV, mono, hepatitis
MSK: RA
Neuro: MS, MG, PD, amyotrophic lateral sclerosis
Other: lupus, malignancy
Chronic fatigue syndrome sx
> 6mo
Not alleviated by rest
Impacts lifestyle + 4 of:
Impaired memory or concentration
HA
Sore throat
Tender cervical / axillary lymph nodes
Muscle pain
Multi joint pain with no swelling
Unrefreshing sleep
Post exertional malaise >24hrs
Kawasaki’s criteria
Fever >5days
Bilateral Conjunctivitis
Erythema (pharynx, lips, tongue)
Peripheral Extremities Changes (Edema, Desquamation)
Polymorphous Rash
Cervical Adenopathy
Kawasaki management
Echo to r/o coronary artery aneurysm
ASA
IVIG
Management principles for febrile sz
Check for sources of fever or infection.
Check for signs of trauma or injury.
Check for signs or symptoms that are considered red flags that would warrant further work-up; persistent neurological symptoms, toxic appearance, atypical seizure presentation, prolonged seizure durations requiring anticonvulsants
Febrile sz counselling for parents
Febrile seizures are common, do not cause brain damage and there is no impact on intellect and future development.
Febrile seizures are likely to happen again and parents need to be prepared and counselled on how to manage these future episodes (fever control, position the child, do not intervene unless needed, time the seizure, review signs and symptoms to consider calling EMS)
There is a small increase in the risk of developing epilepsy with patients presenting with multiple febrile seizures at younger ages.
Hand foot mouth virus
coxsackie (group A)
Management of Infants 0-3 months w/ fever
BC, urine, LP, CXR
How to Ix pts w/ fever of unknown origin
Blood cultures, echo, bone scans
Life threatening causes of fever
Endocarditis
Meningitis
Heat stroke
Malignant neuroleptics syndrome
Sx NMS
Delirium
Diaphoresis
Muscle rigidity
Autonomic instability
Ix for fatigue and when to pursue Ix
Ix if ongoing >4w
CBC
Electrolytes (glucose, creatinine)
LFT
TSH
Pregnancy test
ESR/CRP
UA
Consider
Celiac screen (Anti-TTG, IgA)
CK if pain or muscle weakness
Tuberculosis, HIV, Hepatitis C (born 1945-1965)
Rx for NMS
Rehydration
Cooling
Dantrolene sodium PO
Bromocriptine PO
Myalgic-Encephalitis chronic fatigue syndrome
fatigue profound, not improved by rest, post-exertional malaise
Fibromyalgia criteria
diffuse body pain x3mo w/ no other explanation, fatigue, sleep, mood, cognitive sx
