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Flashcards in Fever and Malignancy Deck (17)
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1
Q

Define a fever?

A

Elevation of temp > 38.4 C, > 101 F

2
Q

Define continuous fever, intermittent/recurrent, remittent

A

Cont: fever all day and won’t fluctuate more than 1 degree C in 24 hours, like with bacterial infections

  1. Intermittent: temp elevation cycles (a lot of fluctuation between normal and fever temps, like malaria or bacterial septicemia)
  2. Remittent: temp above normal all day, but fluctuates MORE THAN 1 degree C in 24 hours (like endocarditis)
3
Q

Some critical noninfectous diagnoses to consider with acute fever?

A

AMI, intracranial hemorrahge, neuroleptic-malignant syndrome, transfusion reaction, pulmonary edema, sickle cell crisis, thyroid storm

4
Q

Define FUO

A

Elevated body temperature (>38.3C) persisting for more than 3 weeks without diagnosis despite one week of investigations in the hospital.

5
Q

Most likely cause of FUO?

A

Etiology: Infections 30%, Malignancy 20%, connective Tissue Disorder 15%, Miscellaneous 20%, and unknown 15%.

6
Q

Some examples of INFECTIOUS FUO’s? Among children and adults, what are most common causes of FUO?

A
  1. Sepsis/abscess
  2. TB
  3. Dental/sinus infections
  4. Bone and joint infections
  5. Infective endocarditis
  6. Viral infections;
    Infections, and abscess and TB, respectively
7
Q

For FUO due to infections, septicemia can be seen with _____ blood cultures; this issue is seen in ____ ____, with up to 5% of cultures remaining negative

A

negative; bacterial endocarditis

8
Q

For MALIGNANCY, which can cause FUO’s? Give me zose constitutional symptoms

A

Lymphoma, leukemia, myeloma, solid tumors (kidney, liver, colon, stomach, pancreas);
B symptoms: weakness, fatigue, anorexia, weight change, fever/chills, lumps, NIGHT SWEATS (TB and malignancy)!!!

9
Q

For CT DISORDERS, what could cause FUO? (Vin Rhymes Slams Giant Pussy)

A
  1. Vasculitis
  2. Rheumatoid
  3. SLE
  4. Giant cell arteritis
  5. Polymyositis
10
Q

Misc causes of FUO?

A

Liver disease, sarcoid, drug rxns, thyrotoxicosis, hypothalamic lesions

11
Q

Define factitious fever; how might she appear?

A

Engineered by patient by manipulating the thermometer and/or temp chart;
appears well, temp OVER 41C, absence of SWEATING, normal ESR and CRP despite high fever

12
Q

Does FEELING HOT constitute a true fever?

A

NO; however, rigors/shaking chills implies a rapid rise in body temp

13
Q

What is important in the history?

A
  1. Verify fever
  2. Duration
  3. Mode of onset
  4. Community vs nosocomial exposures
  5. Progression/pattern
  6. Severity
  7. Relieving and aggravating factors
  8. Treatment received and/or outcome so far
  9. Associated symptoms (localizing could indicate source of the fever)
14
Q

Symptoms you want to consider with fever?

A

Respiratory tract, GU, abdo, CONSTITUTIONAL SYMPTOMS, excessive sweating or none, night sweats, headache, delirium, muscle pain, and then

  1. erythema nodosum (tibia and thought to represent a delayed hypersen reaction)
  2. erythema chronicum migrans (lyme disease)
  3. Neisseria (meningitis)
15
Q

For PMH and PSH, what should you look for?

A

Diabetes, inflamm disease, TB, malignancy, valve heart disease (immunocomp);
Surgery type, trauma, dental interventions

16
Q

Drug fever causes?

A
  1. Penicillins and cephalosporins
  2. Sulphonamides
  3. Antiepileptics
  4. Anti TB agents
17
Q

SH for fever?

A

Smoker, water supply, animals/birds in the home, consumption of unpasteurized milk/milk products, sexual history; travel: endemic area for malaria, any exposure to fresh water, any unprotected sex, exposure to insect bites