Fever

Question 1

What temperature is considered a fever?

Answer 1

Greater than 100.4 F

Question 2

How much can a healthy person’s temperature vary throughout the day?

Answer 2

As much as 3.6 F

Question 3

When is body temperature the lowest? When is it the highest?

Answer 3

Lowest at 6:00am

Highest at 6:00pm

Question 4

What method of obtaining body temp is the most accurate?

Answer 4

Rectal

Question 5

What is the accuracy of oral temperature taking?

Answer 5

Usually underestimates by approx 0.4 degrees F

Question 6

What method of obtaining body temp is least accurate?

Answer 6

Axillary/temporal

Question 7

Define malignant hyperthermia

Answer 7

• Hypermetabolism involving skeletal muscle

- Triggered by inhaled anesthetics or succinylcholine

Question 8

Post-op causes of fever

Answer 8

• Wind (days 1-2 post op, inflamm 2/2 trauma/stress)
• Water (days 3-5, UTIs esp if Foley still in place)
• Wound (days 4-6, cellulitis/abscess)
• Walking (days 5-7, DVT)
• Wonder drugs or Womb (days 7+, drugs reaction or OBGYN infection)

Question 9

What is most likely cause of fever 1-2 days post op?

Answer 9

Inflammatory 2/2 trauma or stress (WIND)

Question 10

What is most likely cause of fever 3-5 days post op?

Answer 10

UTIs (WATER)

Question 11

What is most likely cause of fever 4-6 days post op?

Answer 11

Cellulitis, abscess (WOUND)

Question 12

What is most likely cause of fever 5-7 days post op?

Answer 12

DVT, thrombophlebitis (WALKING)

Question 13

What is most likely cause of fever 7+ days post op?

Answer 13

Drug reaction or OBGYN infection (WONDER Drugs or WOMB)

Question 14

For every 1 degree F increase, how much does HR change?

Answer 14

Increased by 10 bpm

Question 15

How is metabolism affected by increase in body temp?

Answer 15

Increases 7% for each 1 degree increase

Question 16

How does fever affect immune function?

Answer 16

Fever enhances immune function and may act protectively

Question 17

Body temp over 106 degrees F may lead to what?

Answer 17

ICB
Rhabdo
Organ damage

Question 18

Define delirium

Answer 18

Fluctuating disorder of consciousness

Question 19

Define left shift

Answer 19

Increased production of immature WBCs (aka bandemia)

Question 20

What does absolute neutrophil count determine?

Answer 20

Degree of immunocompromise in chemo

Question 21

When is lactic acid elevated?

Answer 21

When body breaks down carbs to use for energy during times of low oxygen levels (e.g. sepsis)

Question 22

When should acetaminophen be avoided?

Answer 22

Liver failure

Question 23

When should ibuprofen be avoided?

Answer 23

Gastric ulcer
(dose reduce in renal failure)

Question 24

Define fever of unknown origin

Answer 24

Fever for over 3 wks with no identified cause after 3 days of hospital eval OR 3 outpatient visits

Question 25

Etiology of fever of unknown origin

Answer 25

Infections (25-50%) CT disorders (10-20%) Neoplasms (5-35%)

Question 26

Define distributive shock

Answer 26

- Hypotension resulting in compromised end-organ oxygenation | - 2/2 decreased vascular resistance (despite normal circulatory volume)

Question 27

Define systemic inflammatory response syndrome (SIRS)

Answer 27

2 or more of: - Oral/rectal temp over 100.9 or under 96.8 - HR over 90 bpm - RR over 20 or PCO2 under 32 - WBC over 12,000 or under 4,000

Question 28

Define sepsis

Answer 28

SIRS due to documented or suspected infection

Question 29

Define severe sepsis

Answer 29

- Septic shock | - Sepsis plus evidence of acute organ dysfunction or tissue hypoperfusion

Question 30

Mortality rate of sepsis?

Answer 30

Declining but the incidence of sepsis is increasing which results in more annual deaths

Question 31

Community acquired etiologies of sepsis

Answer 31

- PNA - UTI - ABD/GYN source - Skin cellulitis/abscess - Meningitis - Endocarditis (IVDA)

Question 32

Hospital acquired etiologies of sepsis

Answer 32

- IVs/Foleys - Intubation - Ulcers/wounds - Surgery/procedures - ICU admission

Question 33

Etiologies of non-bacterial SIRS

Answer 33

- Pancreatitis - PE - Burns - Fungal - Viral (flu, CMV) - Autoimmune (SLE) - Anaphylaxis

Question 34

What is RUSH in regards to sepsis?

Answer 34

Rapid Ultrasound for Shock and Hypotension

Question 35

Sepsis metrics to be completed within 3 hours

Answer 35

- Lactate level - Blood cultures - Broad spectrum abx - Saline - O2

Question 36

Sepsis metrics to be completed within 6 hours

Answer 36

CENTRAL LINE - Vasopressors to maintain MAP over 65 - ScvO2 measurement - Recheck lactate - CVP measurement if possible

Question 37

Goals of sepsis metrics

Answer 37

- MAP over 65 - Urine output over 0.5 mL/kg/hr - ScvO2 over 70% - Normal lactate

Question 38

Empiric abx for sepsis treatment

Answer 38

Ceftriaxone plus Vancomycin

Question 39

What is CURB-65?

Answer 39

Pneumonia severity scoring - Confusion - Urea over 20 - Resp rate over 30 - Blood pressure (SBP under 90 or DBP under 60) - Age 65+

Question 40

Define fixed drug eruption

Answer 40

- 1 or more annular erythematous patches | - Normally resolve w/hyperpigmentation and may recur at same site with re-exposure to the drug

Question 41

Define urticaria

Answer 41

- Hives - Vascular reaction of skin marked by smooth, slightly elevated wheals - Pruritus

Question 42

Define angioedema

Answer 42

-Swelling of deep dermis, SQ or submucosal tissue due to vascular leakage -Tongue, lips, periorbital (GI or pulm possible)

Question 43

Define anaphylaxis

Answer 43

- Shock state secondary to allergen trigger | - Results in hypotension, bronchospasm, GI/uterine contraction, urticaria/angioedema

Question 44

Describe exercise induced allergic reaction

Answer 44

- Exercise triggers food allergy within 1-4 hrs of eating | - MC wheat, corn, garlic, veggies, shellfish

Question 45

How to treat mild allergic reaction

Answer 45

- Monitor and IV access - Benadryl - Steroids - H2 blocker

Question 46

How to treat severe allergic reactions

Answer 46

- 2 IVs, benadryl, steroids, H2 blocker - Epi - Albuterol - Vasopressors, glucagon, intubation may be necessary

Question 47

Treatment of ACE induced angioedema?

Answer 47

- NOT responsive to traditional allergic treatment | - FFP 2-4 units IV

Question 48

Define scombroid poisoning

Answer 48

- Improper fish storage | - High levels of histidine in flesh converted to histamine (heat resistant, cooking will not affect it)

Question 49

Onset of scombroid poisoning

Answer 49

Few mins to hours from consumption of fish

Question 50

Clinical presentation of scombroid poisoning

Answer 50

- Rash and flushing of face/upper body resembling a sunburn - Diarrhea, vomiting - Palpitations, sweating, HA - Burning or swelling of mouth - Metallic taste

Question 51

Treatment of scombroid poisoning

Answer 51

- Generally self limited - Anithistamine PRN - Epi if severe