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Details

Infection and Immunity 2- Lecture 14, 15
Fever
35
Medical
Professional
04/28/2013

Additional Medical Flashcards

 


 

Cards

Term
Normal body temperature variation during the day
Definition

0.6-1.0°C

 

Lowest in morning, highest in late afternoon

Term
Where in body temperature regulation is controlled
Definition
Hypothalamus- preoptic area
Term
The normal human body temperature in Celsius
Definition

37°C (if taken internally)

36.8°C (if taken orally)

Term
Body temperature difference between males and females
Definition
Women tend to be warmer
Term
A fever is a temperature greater than ___ orally, or ___ rectally
Definition

>37.8°C orally

>38.3°C rectally

Term
Hyperthermia vs. fever
Definition

Hyperthermia= body's heat production exceeds heat loss. No reset of temperature regulation.

 

Fever= body resets thermostat to run hotter

Term
Exogenous vs. Endogenous (4) pyrogens
Definition

Exogenous= things/events that stimulate the immune system to cause fever

 

Endogenous= inflammatory or pyrogenic cytokines (IL-1, IL-6, TNF, and Interferons) produced by phagocytic cells

Term
Give the 4 steps of how pyrogenic cytokines cause fever
Definition

1. Pyrogenic cytokines act on hypothalamic
endothelial cells

2. Stimulate production of PGE2

3. PGE2 attaches to glial cells and stimulates release of cyclic AMP

4. Cyclic AMP activates hypothalamus to increase body temperature

Term
Name 4 acute phase proteins produced by the liver as part of the acute phase response to support host defense in infections
Definition

1. Fibrinogen

2. CRP

3. Serum amyloid A

4. Complement proteins

Term
Metabolic rate increases ___% for each degree Celsius elevation in fever
Definition
12%
Term
4 metabolic changes in fever
Definition

1. HR increases

2. water loss

3. Hyperventilation

4. Decrease in serum iron and zinc

Term
5 Benefits of fever
Definition

1. enhanced immune function

2. enhanced neutrophil function

3. improved outcome in certain infections

4. inhibits growth of some pathogens (like Treponema pallidum)

5. Reduced pathogen growth in low iron

Term
4 Harmful effects of fever
Definition

1. seizures in kids < 5 yo (treatment of fever doesn't prevent them either)

2. increased metabolic demand in ppl with already poor lungs or heart

3. can worsen encephalopathy and cause mental dysfunction in the elderly

4. Teratogenic in pregnancy (maybe)

Term
Treat fever with ___ or ___
Definition
acetaminophen or NSAIDS (they don't block cytokine production or Acute Phase Response)
Term
A drug that can cause hyperthermia
Definition
anticholinergic overdose
Term
Treat malignant hyperthermia with ___
Definition
dantrolene
Term
Decrease release of endogenous pyrogens with ___
Definition
corticosteroids
Term
Why shouldn't we physically cool people with fevers? (like with ice) (3)
Definition

Increases oxygen consumption

Can cause vasospasm of diseased coronary arteries and cause MI

Can get rebound hyperthermia

Term
Definition of Classical Fever of Unkown Origin
Definition

fever (>38.3°C) on several occasions and more than three weeks’ duration

 

uncertain despite appropriate investigations after at least three outpatient visits or three days in hospital

Term
Definition of Nosocomial Fever of Unknown Origin
Definition

fever (>38.3°C) on several occasions in a hospitalized patient receiving acute care; infection not present or incubating on admission

 

uncertain after three days despite appropriate investigations, including at least two days incubation of  microbiologic cultures

Term
Definition of Neutropenic Fever of Unknown Origin
Definition

 fever (>38.3°C) on several occasions; neutrophil count
<500/mm3 in peripheral blood, or expected to fall below that number within 1-2 days

 

uncertain after three days despite appropriate investigations, including at least two days incubation of  microbiologic cultures

Term
Definition os HIV-associated Fever of Unknown Origin
Definition

fever (>38.3°C) on several occasions of more than three weeks’ duration as an outpatient or more than three days’ duration in hospital; confirmed positive HIV serology

 

uncertain after three days despite appropriate investigations, including at least two days incubation of  microbiologic cultures

Term
4 Major diagnostic categories of Classic Fever of Unknown Origin
Definition

Infectious

Neoplastic

Non-infectious inflammatory disorders

Other (granulomatous or other things)

Term
5 Types of tumors that can cause a Fever of Unknown origin
Definition

Lymphomas

Leukemia (especially preleukemia phase)

Hypernephroma, Hepatoma

Tumor necrosis

Atrial myxoma

Term
Giant cell arteritis is a ___ disease that can cause a fever of unknown origin.
Definition
granulomatous
Term

Giant Cell Arteritis (aka Temporal Arteritis)

- who gets it

- 4 symptoms

- 1 lab finding

- how to confirm diagnosis

Definition

Who: In elderly (>50 yo)

Symptoms: headaches, fever, proximal girdle soreness, possible blindness

Lab: ESR>50 (high)

To diagnose: temporal artery biopsy

Term
2 common drugs that can induce drug fever (although any drug CAN cause it)
Definition

Antibiotics

Anti-seizure drugs

Term
What are the fever patterns (symptoms) in drug fever? (3)
Definition

intermittent fever with rigors

sometimes a rash (20%)

Term
2 Lab findings in drug fever
Definition

Eosinophilia 20%

Leukocytosis 20%

Term

Factitious Fever

- who gets it (2)

- other illnesses associated

- 2 forms of it

Definition

Young women with training in healthcare

NO other illnesses (no psychiatric illness)

Fradulent or Self-induced

 

(is a form of Munchausen's Syndrome)

Term
Top 6 leading causes of Fever of Unknown Origin in community hospitals (not including "miscellaneous")
Definition

1 & 2. Lymphoma and Collagen Vascular Diseases (16% each)

3. Abscesses (13%)

4. Undiagnosed cause (9%)

5. Solid Tumor (8%)

6. Thrombosis or Hematoma (7%)

Term

Usual cause of fever + chills

 

Definition
Infectious cause
Term
Usual cause of fever + weight loss with preserved appetite
Definition
Infectious cause
Term
Usual cause of fever + weight loss with decreased appetite
Definition
neoplastic cause
Term
3 Stages of evaluating a fever of unknown origin
Definition

1. Screening stage (screening labs, H&P, and imaging)

2. Non-invasive evaluation stage (focused labs and imaging)

3. Invasive Stage (procedures, like biopsy)

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