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Flashcards in Fever Deck (25):
1

What is PUO?

Pyrexia of Unknown Origin

2

how is PUO defined?

Prolonged Illness (2-3 weeks)
Fever (above 38.3C)
No diagnosis after exhaustive investigation

3

what is the normal range for oral temperature?

35.8 - 37.8

4

when is body temperature the lowest?

morning

5

where is body T regulated?

Anterior Hypothalamus

6

mechanisms of heat loss include?

peripheral vasodilation, sweating and reduced physical activity

7

heat production mechanisms include?

shivering and increasing metabolic rate
release of thyroid hormone
glucocorticoids
catecholamines [epinephrine, norepinephrine, dopamine]

8

what is the definition of fever?

oral morning Tem > 37.2
oral Temperature > 37.8

9

what is the difference between oral and axillary Temps with core Temp?

oral <1

10

why is increasing temperature a physiological mechanism?

because some immune activities are best functional at 39.5 [immune, endocrine, physiological]
also bacteria tend to work less effectively at higher temps

11

main inducers of fever?

TNFa
IL-1ß
IL-6
IFN-y

12

how is the effect of cytokines mediated in the anterior hypothalamus?

inducing of COX-2 and breaking down of membrane arachidonic acid to produce PGE2 (prostaglandin)

13

Describe Rigor

feeling of uncontrolled shivering and intense cold sensation with pallor and pilo-erection. Main mechanism used to INCREASE BODY TEMP

14

during the rigor phase of a fever temp is high T/F

F, temp is normal and increases afterwards

15

sudden sustained fever with the patient coming into the ER must be treated by

Resuscitation
stabilisation
Empirical Antibiotics (check for risks in order to establish this)

16

some of the alarm bells that indicate serious infection in re: fever

rapid onset/evolution
rigors
severe muscle pains
impaired conscious state
vomiting (sign of ICP)
severe headache
rasch
jaundice

17

investigation of acute serious fever

FBE, CRP, renal/liver function
blood culture, urine culture
CXR

18

if WCC and CRP are fine then the patient does not have an infection, specially if it recedes with panadol and IV fluid T/F

F, some parameters only increase around 12 hours

19

for prolonged fever empirical antibiotics are recommended?

NOT, unless Q fever or atypical pneumonia likely
BETTER to test the patient first UNLESS Hx of travel to plasmodium vivas country (2 years B4)

20

clinical approach to PUO

start again
1 onset and duration
2 seek localising symptoms
3 establish severity
4 is there really a fever?
5 obtain info and review all results
6 look for clues, past Hx Fx Mx
7 country of origin
8 travel Hx
9 occupation, animal exposure
10 Secual Hx and IV drug use

21

pyrexia associated with a history of handling cattle

Q fever caused by Coxiella burnetii
respiratory disease The most common manifestation is mild flu-like symptoms with abrupt onset of fever, malaise, profuse perspiration, severe headache, myalgia (muscle pain), joint pain, loss of appetite, upper respiratory problems, dry cough, pleuritic pain, chills, confusion and gastrointestinal symptoms, such as nausea, vomiting and diarrhea. The fever lasts approximately seven to 14 days. can also produce atypical pneumonia

22

what are the most common causes PUO?

30 infectious
30 autoimmune
30 malignancies
10 other

23

what is benign pyrexia?

mild fever with no apparent cause

24

what is the most common cause of malignancy PUO

lymphomas

25

PUO in people with HIV

Mycobacterium avium complex (MAC), CMV or cryptococcus, histoplasma