fever

Question 1

whats dose mean fever ?

Answer 1

increase in the temprture more than 37.8C

Question 2

what the differanc between the recal axillarly and ear drum and skin temprture ?

Answer 2

rectal and eardrum is higher by 0.4

while the acillary and skin lower by 0.4

Question 3

whts the hyperpyrexia ?

Answer 3

temprture is more than 40

Question 4

what the most common cause of pyrixia of unknown etiology ?

Answer 4

a common disese presented in atypical way

Question 5

what the old and new defintion of fever pf unknown cause

Answer 5

old 
---- 
1- temp more than 38.3c 
2- fever last for 3 week 
3- no dignosis for 1 week 

3 out visit and stay at hospital for 3days and no dignosis

Question 6

what the most common causes of the PUO?

Answer 6

1- infection (40-60)
2-malignency (20)
3-CT disease disorder (15)
4-miscellaneous (20)

Question 7

whatre the type of infection cause pyrexia ?

Answer 7

1-abscess in liver ,renal and colon

2- infection in the oral cavity
3- bone and joint infection
4-infective endocarditis

organism 
--------
Tuberculosis 
HIV -1
CMV and EBV
fungal infection 

من السفر
1- imported infection
2-nosocomial infection
3- HIV +

Question 8

whatre the type of malignency ?

Answer 8

1- heamatological
as leukemia and lymphoma

2-soild tumeer
in the liver in the kidney ,….

Question 9

what are the CT disese in the older age ?

Answer 9

polymalgia rheumatica

and temporal arteritis

Question 10

whatre the CT disese in the younger age ?

Answer 10

PB SV

1- polymitosis
2- بهجت disease
3-still disease juvenile rheumatoid arthritis
4-SLE

Question 11

whatre geogrophic contriction in CT disese ?

Answer 11

rhumatioid fever

Question 12

whatre CT disese ?

Answer 12

polymalgia rhumatica
temporal arteritis

young 
--------
still disese 
systemic lupus arthritis 
بهجت disease 
polymitosis

rhumatoid fever

Question 13

whatre te micellenous causes of the fever ?

Answer 13

1- cardiovacular
aterial myxoma and aortitis and aortic disection

2- haemtological
haemtological anemia ,thrombocytopenic purpra and graft versus host disease

3-GIT
Inflalmmtory bowel disease and pancreatitis and heptitis

4- endocrine/metabolic
Thyrotoxicosis, phaeochromocytoma, adrenal insufficiency, hypertriglyceridaemia

5-inherted
mediterian fever and periodic fever syndrom

6-drug reaction
antibiotic and drug hypersensivty

Question 14

whatre the causes of drug fever ?

كلششش مهم

Answer 14

1- hypersensivty to the drug as
pencillin ,methyldopa, sulfa

2- malignant hyperthermia
(high fever + muscle contraction ) cause is the general
anesthesia

Neuroleptic malignent syndrom NMS
reaction happen due to epilyptic and anti-pschatric drug

3- fever related to the action of the drug
as J-H reaction
means having fever and skin rash after taking pencillin for syphilis

4- drug adminstration related to the fever
amphotercin B And belomycin

5- MAO inhibtors (antidepressent ) drug affect of thermoregulation

6-pharmacological action

jarsh herxheimer reaction ( after using the antibiotic that causing dath to the organism )

tumer cell necrosis by cytotoxic drugs

Question 15

whats the factitious fever?

Answer 15

1- pt ahve high fer more than 41c 
2- but looks well
3-no sweating 
4-noraml ESR and Creactive protein 
5-normal tempruture during observed measurment 

Evidence of self injection

Question 16

how to take history of pt PUO?

Answer 16

1-duration and the charector of the fever

2- contact with other people with same syptomas

3- history of travel conona and malaria

4-expose to the pet and past medical list

5-assocaited syptomas

if fever + weight loss + LN enlargment =lymphomaand leukemia

if fever +skin rash +arthritis = SLE and juvenile arthritis

Question 17

whatre the causes of of fever and skin rash ?

Answer 17

كرم ت

1-Chichen box 
2-Rubella 
3-Measls 
4-typhus 
5- typhoid

+ some drugs

Question 18

whatre the cause of fever and lymphadenoathy ?

Answer 18

بسكت
bsct

1- brucellosis
2-syphilis
3-CMV/EBV/Aids

4-toxoplasmosis

Question 19

fever and jaundice causes ?

Answer 19

heptitis
and cholangitis

malaria and yellow fever

Question 20

fever and pulmanry involvment ?

Answer 20

1-influenza
2-pnemonia
3-SARS and MERS

Question 21

whtre the proment causes of the fever in elderly ?

Answer 21

1- infection as Tb intarabdomianl abscesss UTI and infective endocarditis

2- Ct disease as polymalgia rhumatica / temporal arteritis tumer

mainly attributable to malignancy in older patients

Question 22

fever should be treated in the fallowing:

Answer 22

1- elderly 
2- childern with fit 
3-pregnent 
4-temperture more than 39C 
5- preexisting disease like IHD Strok and pulmnary diseas

Question 23

what is the mortality ration of PUO

Answer 23

30-40%

Question 24

the common cause of the PUO ?

Answer 24

infection

Question 25

common disease presenting in abnormal way ?

Answer 25

true

Question 26

3 viral example of PUO

Answer 26

HIV virus came from outside like corona EBV CMV

Question 27

Endocrine cause of PUO

Answer 27

Thyrotoxicosis Phaeochromocytoma Adrenal insufficiency

Question 28

what are the possible cause in fever 10 day s develop skin rash if it not typhoid ? what could be

Answer 28

1- Typhoid fever | 2-drug allergy as Infectious mono nuclesis /Sulfa drug

Question 29

what is drug fever?

Answer 29

Fever that develope due to drug action or due to its effect on thermoregulation or hypersensitivity

Question 30

what are the pattern of fever in typhoid

Answer 30

Stepladder

Question 31

what are the sequence of symtoms after the low grade fever

Answer 31

headach ,malaise ,bradycardia and constipation

Question 32

what are the signs in the second week

Answer 32

``` fever Cough Abdomenal distention Diarrhea Rose sopt spleenomeglay ```

Question 33

Dx test in typhoid

Answer 33

1- blood culture for blood and BM 2-widdle 4 raise 3- aglutination

Question 34

How you treat pregnant lady with typhoid?

Answer 34

third-generation cephalosporins and ampicillin/amoxicillin

Question 35

what're the metabolic causes of the fever ?

Answer 35

Thyrotoxicosis, phaeochromocytoma, adrenal insufficiency, hypertriglyceridaemia

Question 36

what're the heamatological causes of the fever ?

Answer 36

1-Haemolytic anaemia 2-thrombotic thrombocytopenic purpura, 3-myeloproliferative disorders 4-graft-versus-host disease

Question 37

what're the inherted disese that causing the fever ?

Answer 37

1-Familial Mediterranean fever حمى الشرق الاوسط | 2- periodic fever syndromes

Question 38

what're the GIT problem which causing fever ?

Answer 38

1- Inflammatory bowel disease 2-hepatitis 3- pancreatitis

Question 39

what're the pulamnary problem that causing the fever ?

Answer 39

1-pulmonary embolism | 2-extrinsic allergic alveolitis

Question 40

what're the cardiac problem that can causing the fever?

Answer 40

1-Atrial myxoma 2-aortitis 3-aortic dissection

Question 41

which type of drugs causing fever ?

Answer 41

cytotoxic drugs --- casing fever by it's Pharmacological action of the drug Jarish-Herxheimer reaction -MOA inhibitors can causing fever by effecting on thermoregulation +They are best known as powerful anti-depressants, as well as effective therapeutic agents for panic disorder and social phobia. -Amphotericin B is an antifungal medication used for serious fungal infections Bleomycin is a medication used to treat cancer. these can causing fever only by adminstration - JH reaction was defined as presence of fever (temperature, >38.0°C) and/or acute exacerbation of maculopapular skin rashes within 24 hours of receipt of penicillin therapy for syphilis. - Malignant hyperthermia (MH) is a disease that causes a fast rise in body temperature and severe muscle contractions when someone with MH gets general anesthesia. MH is passed down through families. Hyperthermia means high body temperature - Neuroleptic malignant syndrome (NMS) is a life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication. Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate. - Hypersensitivity ( Penicillin, methyldopa, Sulpha) - Amoxicillin rash in patients with infectious mononucleosis infectious diseases are the most common causes related with fever and rash, but it is also important to consider rheumatic and neoplastic diseases, drugs, allergens, and sometimes idiopathic causes. common infectious diseases with fever and rash are transmitted by vector: Typhus, rickettsial spotted fever, Rocky Mountain spotted fever, Lyme disease, ehrlichiosis, and tularemia

Question 42

what's the Factitious fever?

Answer 42

Factitious fever is one of the causes of fever of unknown origin. It is usually an atypical presentation of a common disease It represents a large group of false illnesses varying from malingering to personality disorders. 1-patient who looks well 2-Temperature > 41°C 3-Normal temperature during supervised (observed) measuremen 4-Absence of sweating 5-Normal ESR and CRP despite high fever مخطط درجة حرارة غريب مع عدم وجود اختلاف نهاري 6-Bizarre temperature chart with absence of diurnal variation 7-Evidence of self-injection +Factitious Fever is more common amongst medical and paramedical staff e.g. nurses, pharmacists, bacteriologist, because of the prompt attention Fever can also be produced by self inoculation of bacterial cultures, toxoids and milk. Cases of recurrent abscesses, cellulitis and self inflicted skin lesions due to self injection of tetanus toxoid, coliform bacilli wo subgroups of patients with factitious disease are seen. First group comprises of younger patients who manipulated their thermometers after a genuine episode of fever; just to gain atten- +-+0tion. Their psychopathology varies. The second group is of older subjects with serious underlying psychiatric ifiness (borderline syndrome). They create illness by self infection. The term borderline syndrome is applied to a heterogenous group of patients whose personality varies between neurosis and psychosis (Knight, 1953; Grinker et al., 1968; iCernberg, 1967; Gunerson and Singer, 1975; Stone, 1977; Perry and Klerman, 1978). Borderline cases have defects in theif self concepts, reality testing, and impulse control. They are superficially social but have feelings of hidden anger, hostility and self destruction.

Question 43

fever from travel

Answer 43

HIV , Corona , Malaria الي يجي من ايران كورونا من امريكا ايدز من الهند ملاريا

Question 44

fever caused by Exposure to pets and other animals or unpasteurized milk?

Answer 44

leptospirosis, cat scratch dis Leptospirosis is a relatively rare bacterial infection that affects people and animals. It can pass from animals to humans when an unhealed break in the skin comes in contact with water or soil where animal urine is present. Several species of the Leptospira genus of bacteria cause leptospirosis.

Question 45

fever + skin rash + arthritis means ?

Answer 45

1-SLE | 2-Juvenile arthritis

Question 46

fever + cough +wt. loss+ lymph node means

Answer 46

lymphoma, Leukemia

Question 47

Fever + skin rash after one day means

Answer 47

Chicken pox

Question 48

Fever + skin rash after 2 day means

Answer 48

Rubella

Question 49

Fever + skin rash after 3 day means

Answer 49

Measles

Question 50

Fever + skin rash after 4 day means

Answer 50

Typhus

Question 51

Fever + skin rash after 5 day means

Answer 51

typhoid

Question 52

Fever and lymphadenopathy

Answer 52

1-Brucellosis unpasteurized milk malta fever also causing spleenomegly البقره 2-Toxoplasmosis, القط 3-CMV, EBV, AidsHIV ----sex 4-Syphilis Syphilis is a bacterial infection usually spread by sexual contact. ---sex

Question 53

Fever and Jaundice

Answer 53

1-Cholangitis 2-hepatitis , 3-malaria , 4-yellow fever

Question 54

Fever and pulmonary involvement

Answer 54

Influenza Pneumonia Sever Acute Respiratory syndrome SARS, MERS

Question 55

investigation of PUO ?

Answer 55

``` A- Microscopy B. Culture C. Antigen detection D. Nucleic acid detection(PCR) E. Immunological tests ``` 1-Serology (antibody detection) for viruses, fungi and bacteria and protozoa 2. Interferon-γ release assay for diagnosis of TB F- Additional investigations in PUO

Question 56

what's the microscbical investigation include ?

Answer 56

1-Blood for atypical lymphocytes (EBV, CMV, HIV-1, hepatitis viruses or Toxoplasma gondii), trypanosomiasis, malaria. 2. Stool for ova, cysts and parasites 3. Urine for RBC, WBC , schistosome ova 4. Sputum for mycobacteria, fungi ``` 5. Biopsy : light microscopy (mycobacteria, fungi, Leishmania) electron microscopy (viruses, protozoa ) ```

Question 57

what're the cultures of fever?

Answer 57

1. Aspirates and biopsies (e.g. joint, deep abscess) 2. Blood, including prolonged culture and special media 3. Sputum for mycobacteria 4. Cerebrospinal fluid (CSF) 5. Stool and Urine

Question 58

Antigen detection include

Answer 58

1. Blood e.g. HIV p24 antigen, 2. CSF for cryptococcal antigen 3. Bronchoalveolar lavage fluid for Aspergillus 4. throat swab for respiratory viruses 5. Urine, e.g. for Legionella antigen

Question 59

PCR include

Answer 59

1. Blood for Bartonella spp. and viruses 2. CSF for viruses and bacteria 3. throat swab for viruses 4. Bronchoalveolar lavage for resp. Viruses 5. Tissue specimens, e.g. for Tropheryma whipplei 6. Urine e.g. for Chlamydia trachomatis, Neisseria g. 7. Stool e.g. for norovirus, rotavirus

Question 60

Serology

Answer 60

(antibody detection) for viruses, fungi and bacteria and protozoa

Question 61

Interferon-γ release assay

Answer 61

for diagnosis of TB

Question 62

TB DIGNOSIS

Answer 62

Interferon-γ release assay microscopical biobsy microscopy Sputum

Question 63

Additional investigations in PUO

Answer 63

``` Serological tests Autoantibody screen, Complement levels Echocardiography Ultrasound of abdomen CT/MRI of thorax, abdomen and/or brain ``` ``` Imaging of the skeletal system Plain X-rays, CT/MRI spine, Isotope bone scan Labelled white cell scan Positron emission tomography (PET) Biopsy Bronchoscopy and lavage , Lymph node aspirate or biopsy Biopsy of liver Bone marrow aspirate and biopsy Temporal artery biopsy ```

Question 64

what we do for the blood investigation ?

Answer 64

``` - microscpoe atypical lymphocytes (EBV, CMV, HIV-1, hepatitis viruses or Toxoplasma gondii), trypanosomiasis, malaria. ``` - culture - antigen HIV p24 antigen -PCR Bartonella spp. and viruses Cat scratch disease

Question 65

what we do for the stool investigation ?

Answer 65

-microscope ova, cysts and parasites - culture - antigen - PCR for norovirus, rotavirus

Question 66

what we do for the urine investigation ?

Answer 66

- microscope RBC, WBC , schistosome ova - culture - antigen Legionella antigen - PCR for Chlamydia trachomatis, Neisseria g

Question 67

what we do for the sputum investigation ?

Answer 67

-microscope mycobacteria, fungi -culture mycobacteria -antigen throat swab for respiratory viruses Bronchoalveolar lavage fluid for Aspergillus -PCR throat swab for viruses

Question 68

what we do for the biobsy investigation ?

Answer 68

``` -microscope light microscopy (mycobacteria, fungi, Leishmania) electron microscopy (viruses, protozoa ) ``` - culture . joint, deep abscess - PCR Tropheryma whipplei Whipple disease is caused by a type of bacterium called Tropheryma whipplei. The bacteria affect the mucosal lining of your small intestine first, forming small lesions within the intestinal wall. There are 3 main forms of leishmaniases – visceral (also known as kala-azar, which is and the most serious form of the disease), cutaneous (the most common), and mucocutaneous

Question 69

what we do for the. CSF investigation ?

Answer 69

-culture -antigen cryptococcal antigen -PCR viruses and bacteria