Fever

Question 1

normal body temperature

Answer 1

35. 8 - 37 C

96. 5 - 99 F

Question 2

fever temperature

Answer 2

40 C

104.0 F

Question 3

clinical importance of body temp

Answer 3

1) determine severity of illness in adults
2) course & duration of illness
3) effect of therapy on illness

Question 4

2 exceptions in temp determining severity of illness

Answer 4

1) febrile response of kids is greater > adults

2) geriatric & neonatal responses are less marked or even absent

Question 5

rectal temp

Answer 5

better estimate of core temp

1. 0 F
2. 5 C higher than oral

Question 6

normal diurnal variation

Answer 6

96.5 F in morning
99.3 F in afternoon
~ 1 F higher in afternoon

Question 7

Tx of fever

Answer 7

• -most fever is well tolerated
• • <40 C (104 F) symptomatic tx only
• • > 41 emergent management
• -anti-pyretic therapy only needed in marginal hemodynamic status

Question 8

pediatrics & fever

–philosophy

Answer 8

• -fever is friend

- -anti-pyretics may prolong illness

Question 9

emergency care required when…

Answer 9

• • <2m old w/ temp >100.9 F

- - >2m temp >106 F

Question 10

important feature to watch for in kids w. fever =

Answer 10

• -significant change in demeanor
  1) kid act ill & not eat as much = normal
  2) not drink water, not eat food/things they like = ER/ pediatrician

Question 11

benefits of fever

Answer 11

• -draws attention to underlying condition
• -therapeutic effects
• activation of IL-1 mediated immune responses
• increase chemotactic, phagocytic & bactericidal activities or neutrophils

Question 12

detrimental aspects of fever

Answer 12

• -muscle & adipose wasting
• -myalgias & arthralgias
• -CNS alterations (irreversible brain damage >106 F)
• -loss of electrolytes d/t sweating
• -trigger epileptic seizures
• -possible birth defects w. high maternal fever (1st trimester)

Question 13

accompaniments of fever

–systemic symptoms

Answer 13

• -HA
• -arthralgias
• -myalgias
• -tachycardia
• -tachypnea

Question 14

accompaniments of fever

–chills/rigors

Answer 14

• -shaking is d/t cytokines & prostaglandins which set body temp in the hypothalamus.
• -assoc w/ pyogenic infections w/ bacteremia or viremia

Question 15

accompaniments of fever

–changes in mental status

Answer 15

• -most striking in very young & old
• -confusion
• -slowness
• -“sensorium clears w/ defervescence”

Question 16

accompaniments of fever

–convulsions

Answer 16

• -MC in children <5

- -not necessarily a sign of serious cerebral disease

Question 17

accompaniments of fever

ALL

Answer 17

• -systemic symptoms
• -chills/rigors
• -sweating
• -changes in mental status
• -convulsions
• -herpes labialis

Question 18

causes of fever

–infections

Answer 18

• -bacterial
• -viral
• -rickettsial
• -fungal
• -parasitic

Question 19

causes of fever

–rheumatologic disease

Answer 19

• -SLE
• -polyarteritis nodosa
• -rheumatic fever
• -polymyalgia rheumatic
• -giant cell arteritis
• -still’s disease

Question 20

causes of fever

–central nervous system disease

Answer 20

• -cerebral hemorrhage
• -head injuries
• -brain & spinal cord tumors
• -degenerative central nervous system disease
• -spinal cord injuries

Question 21

causes of fever

–malignant disease

Answer 21

• -primary neoplasm

- -metastatic tumors

Question 22

causes of fever

–hematologic disease

Answer 22

• -leukemias
• -lymphomas
• -hemolytic anemias

Question 23

causes of fever

–cardiopulmonary disease

Answer 23

• -myocardial infarction

- -pulmonary embolism

Question 24

causes of fever

–gastrointestinal disease

Answer 24

• -inflammatory bowel disease
• -liver abscess
• -hepatitis

Question 25

causes of fever | --endocrine disease

Answer 25

- -hyperthyroidism | - -pheochromocytoma

Question 26

causes of fever | --disorder due to chemical agents

Answer 26

- -drug rxn | - -rex to anesthesia

Question 27

fever or unknown origin (FUO) | --essential of dx

Answer 27

- -illness of >3 weeks - -temp = >38.3 C OR 101 F - -Dx has not been made after 3 outpatient visits or 3 days hospitalization - -pt cannot have neutropenia OR immunosuppression

Question 28

common causes of FUO:

Answer 28

``` MC = unusual manifestations of common illnesses Adults: infections 25-40% cancer 5-10% autoimmune 10-20% Kids: infections 30-50% cancer 5-10% autoimmune disease 10-20% --40% remain undiagnosed & resolve during further investigation ```

Question 29

basic procedures for eval of FUO

Answer 29

- -Hx, Px, meds - -review previous studies - -blood cultures - -CBC - -ESR - -urinalysis - -Test: syphilis & HIV - -renal & thyroid func - -serum liver & muscle - -serum albumin & globulin - -TB skin test - -Stool occult blood test - -anti-nuclear antibody assay - -biopsy of tissue

Question 30

2nd-level procedures for eval of FUO

Answer 30

- -Ab CT - -dental x-rays - -sinus x-ray OR CT - -Lx x-ray - -viral, amebic, bacterial serologies - -blind bone marrow biopsies

Question 31

3rd level procedures for eval of FUO

Answer 31

- -Ab Ultrasound - -echocardiogram - -bone scan - -laparoscopy/laparotomy - -small bowel OR rectal biopsy - -angiography - -therapeutic trials