Unit 1 - Fever and Malignancy

Question 1

definition of fever

Answer 1

elevation in core body temperature from resetting of thermostatic regulatory system caused by pyrogens

Question 2

what is normal temperature and fever quatitatively?

Answer 2

normal: 36.8 C (+/- 0.4) –> 37 C or 98.6 F
fever: > 38.4 C or > 101 F

Question 3

what are pyrogenic cytokines to keep in mind?

Answer 3

IL-1, IL-6, TNF, IFN

Question 4

what does a continuous fever mean?

Answer 4

fever all day and does not fluctuate more than 1 degree C in 24 hours (in bacterial infections)

Question 5

what does intermittent/recurrent fever mean?

Answer 5

temperature elevation cycles (in malaria, bacterial septicemia, obstruction of calculi causing UTI and cholecystitis)

Question 6

what does remittent fever mean?

Answer 6

temperature above normal all day, fluctuates more than 1 C in 24 hours (in endocarditis)

Question 7

what are critical (noninfectious) diagnoses to consider with acute fever?

Answer 7

AMI or CVA
PE/DVT
intracranial hemorrhage
neuroleptic-malignant syndrome
thyroid storm
acute adrenal insufficiency
transfusion reaction
pulmonary edema
sickle cell crisis
transplant rejection
pancreatitis

Question 8

what is an FUO defined as and what are its common points?

Answer 8

fever of unknown origin is elevated body temperature persisting for more than 3 weeks without diagnosis, despite 1 week of investigations at the hospital

• majority of illnesses are treatable, and are from a common disease presenting atypically
• as duration of fever increases, likelihood of infectious cause decreases

Question 9

etiology of FUO

Answer 9

30% infections
20% malignancy
15% CT disorders
20% miscellaneous
15% unknown

Question 10

4 DDx of fever

Answer 10

1. infectious (tyhpoid, hepatitis A/B, leptospirosis, TB, malaria)
2. malignancies (leukemia, lymphoma)
3. autoimmune conditions, joint/CT disease (RA, rheumatic fever, SLE, vasculitis)
4. others (drug induced fever, IBD, hypothalmic lesions)

Question 11

what are the common FUO infections in adults?

Answer 11

abscess and TB

Question 12

what is the most common cause of FUO in kids?

Answer 12

infections

Question 13

explain the importance of septicemia with negative blood cultures

Answer 13

in proven bacterial endocarditis; up to 5% of cultures can remain negative despite figorous collection techniques due to:

• prior administration of antibiotics
• severe local infection (intra-abdominal, mixtures of aerobic and anaerobic bacteria)
• fastidious, slow-growing organism in blood
• infections due to organisms not routinely cultured (TB, fungus)
• toxemia - toxic shock syndrome

Question 14

what are night sweats a characteristic of?

Answer 14

TB and malignancy

Question 15

what are constitutional symptoms?

Answer 15

weakness, fatigue, anorexia, weight change, fever/chills, lumps, night sweats

Question 16

explain facitious fever

Answer 16

engineered by patient by manipulating thermometer and/or temperature chart

• uncommon, but mostly in young women with medical/nursing background
• clues are:
• -patient appears well
• -absence of temperature-related changes in pulse rate
• -temps > 41 C (falsely high)
• -absence of sweating during period of fever
• -normal ESR and CRP

Question 17

what are three things to take into account for history?

Answer 17

1. chronology
2. contextual history
3. patient’s perspective

Question 18

what does it mean when someone has rigors/shaking chills?

Answer 18

profound chills with chattering of teeth and severe shivering implies rapid rise in body temperature
-sepsis with abscess, lymphoma, malaria

Question 19

what are associated symptoms in chronology of fever?

Answer 19

1. respiratory tract: upper or lower RTI, sinusitis, cough, sputum, wheeze, shortness of breath
2. genitourinary: dysuria, increased frequency of urination, vaginal/urethral discharge, UTI, PID, STI
3. abdominal symptoms: diarrhea with/without blood, weight loss and abdominal pain (gastroenteritis, intra-abdominal sepsis, IBD, malignancy)
4. constitutional symptoms

Question 20

what is headache/photophobia associated with?

Answer 20

meningitis (if severe)

Question 21

what is delirum associated with?

Answer 21

mental confusion during fever is more common in young children and old age

Question 22

what is myalgia associated with?

Answer 22

characteristic of viral infections like influenza and malaria

Question 23

what do macular rashes + fever mean?

Answer 23

measles, rubella, toxoplasmosis, EBV

Question 24

what do hemorrhagic/petechiae rashes + fever mean?

Answer 24

meningococcal infections, viral hemorrhagic fever, Neisseria

Question 25

what do vesicular rashes + fever mean?

Answer 25

chickenpox, shingles, herpes simplex

Question 26

what do nodular rashes + fever mean?

Answer 26

erythema nodosum (usually drugs), TB, leprosy

Question 27

what do erythematous rashes + fever mean?

Answer 27

drug rashes

Question 28

what do joint symptoms mean?

Answer 28

pain or swelling suggests reactive arthritis, mono or polyarticular

Question 29

explain drug fever and common culprits

Answer 29

relatively uncommon, and easily missed

• penicillins and cephalosporins
• sulphonamides
• antiepileptics
• anti-TB agents

Question 30

what is the usual timeframe for fevers from drugs?

Answer 30

kicks in anywhere from 5 to 14 days after beginning to take drug

Question 31

if someone has a fever every third day, what is the most likely DDx?

Answer 31

malaria