Fever and PUO Flashcards Preview

Hugh's Locomotor > Fever and PUO > Flashcards

Flashcards in Fever and PUO Deck (28):
1

What investigations should be ordered for fever?

FBE, CRP, ESR

Renal function, Liver function

CXR

Urine and blood culture

2

Why is prolonged fever disadventageous?

Because fevers are highly metabolically demanding

 

2

Which hormone acts on the fever centre of the hypothalamus to increase the temperature set point?

PGE2

2

What are some signs that take longer to present in prolonged fever?

Cough, crepitations

Lymphenopathy/splenomegaly

Thyroid tenderness/temporal art. tenderness

Arthralgia, rash, arthritis

4

How does body temperature vary throughout the day?

Lowest in the morning

Highest in the afternoon

5

What will the body temperature of a person with rigors be?

Normal - rigors is a part of the process to increase temperature

7

What is the normal oral temperature range?

35.8-37.8

8

How does the body act to lose heat?

Sweat

Peripheral vasodilation

Reduce physical activity

9

Where in the brain is body temperature regulated?

In the posterior hypothalamus by heat sensing neurons

10

What are the leading causes of PUO

Connective tissue disorders ~30%

Malignancies ~30 

Infections ~20%

Other ~10%

- Drug

- Factitious

- Benign pyrexia

10

What is classic cause of intra-abdominal abscesses?

Amoeba that has travelled by the bile duct

12

Why is LPS a more rapid stimulator of fever?

Because it acts directly on the fever centre

13

What is the cut off for fever?

>37.2 for morning oral temperature

>37.8 for oral temperature at any time

13

Who are some at risk patients?

Recent travellers

Asplenic

Neutropenia

IVDU

Diabetic

14

What is piloerection?

Hair standing up

15

What is required for subacute bacterial endocarditis to occur?

Valve abnormality

16

What abnormalities might you see in an FBE of someone with prolonged fever that might be diagnostic?

Neutrophilia left shift - greater proportion of newly produced neutrophils

Atypical lymphocytosis

Malaria

17

When should meningocaemia be considered as the cause of a fever?

Very rapid onset of severe fever and rigors

Accompanied rash

18

What infection should be considered in febrile patients with a history of contact with toddlers?

Cytomegalovirus infection

19

When should falciparum malaria be considered the cause of a fever presentation?

When the patient has a recent history (within a few months) of travel to an endemic zone

20

When should bacterial meningitis be considered as the cause of a presentation of fever?

When there is accompanied heahache and neck stiffness

21

What is the approach to take with some who has PUO?

Take a thorough history 

- onset and duration

- localising symptoms

- severity

Is there really fever?

 

Consider risk factors

- country of origin/travel

- new sexual partners

- animal contact

- IVDU

- occupation

- past hx/ family hx/ new medications

23

When should a necrotising soft tissue infection be considered as the cause of a presentation of fever?

When this is accompanied localised severe pain

24

When should toxic shock symdrome be considered as the cause of a presentation of fever?

When there is accompanied sun burn like rash

25

What infection should be considered in febrile patients with a history of animal/farm contact?

Psittacosis - atypical pneumonia from birds

Q fever from farm animals

26

Why does fever occur?

Create the optimal temperature for certain enzymes to act at

27

What are rigors?

A feeling of intense cold

Uncontrollable shaking

Striking pallor of face and limbs

Piloerection

Leaves suffers exhausted

28

What are the criteria for pyrexia of unknown origin?

Illness for 2-3 weeks

Body temperature of 38.3 on several occasions

No diagnosis after intelligent investigations