Fever

Question 1

what is diurnal temp variation

Answer 1

up in mid-day - indep of time of day

Question 2

what is normal T range

Answer 2

under 38

Question 3

what is practical def. of fever

Answer 3

monitor closely for 37.8-37.9, over 38 abnormal

Question 4

def. of febrie neutropenia

Answer 4

T > 38 x1 orall or >38 for >hour

Question 5

def. of fever of unknown origin (FUO)

Answer 5

fever > 38 on multiple reading over 3 weeks

• no cause after invest
• not applicable to FN, HIV, HSCT, nosocomial aquired

Question 6

what is body thermostat

Answer 6

hypothalamus

Question 7

mech of fever in infection

Answer 7

1. exogenous pyogens
2. activated leukocytes
3. IL-1, TFN, IFN, IL-6
4. vascular epithelium near hypothlamus
5. PGE2 on other side of BBB
6. increase hypothalmic set point

Question 8

what is fever good for

Answer 8

Tmax and survaval correlated in Gr- bacteremia, bact peritonitis

Question 9

disadv of fever

Answer 9

symptomatic - chills, sweats, tachycardia and tachypnea

- no adverse effects in adults

Question 10

possible problem in children

Answer 10

risk of febrile seizures

Question 11

2 situations in which high temp is not a fever

Answer 11

1. hyperthermia - can’t lose heat, set-point not changed

2. hyperpyrexia - T > 41 , usually hypothal. damage

Question 12

DDx of fever

Answer 12

1. infection
2. non-infection inflammatory disorders
3. malignancy
4. vascular thrombosis
5. endocrine
6. drugs/meds

Question 13

how has cause of FUO changed with time

Answer 13

more likely to be no diagnosis in recent times

Question 14

what is standard investigation of FUO

Answer 14

TSH, bloods, TB test, CT chest/abdo, doppler US

Question 15

what is common treatment of fever

Answer 15

Cox blockers

Question 16

what is mech of cox blockers

Answer 16

can’t PGE2 from arachnadonic acids

Question 17

common cox blockers

Answer 17

ASA, acetominophen, NSAIDs

- corticosteroids work, but too many other effects

Question 18

treatment of 3 types of elevated T

Answer 18

fever - acetominophen
hyperthermia - cool body - no antipyretics
hyperpyrexia - cool body and anti-pyretics