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37 Cards in this Set
- Front
- Back
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What is the difference between fever and hyperthermia?
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• fever is an increase in body temperature through physiologic mechanisms
• hyperthermia is an increase in body temperature that overrides or bypasses the normal homeostatic mechanisms |
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What are some causes of hyperthermia?
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• CNS disorders (ex. paraplegia)
• heat stroke • reactions to anesthetics (mallignant hyperthermia) • reaction to phenothiazines (neuroleptic malignant syndrome) • vigorous exercise |
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What are some characteristics of heat stroke?
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• body temperature greater than 40.6º C (105º F)
• associated with coma and with cessation of sweating |
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Listeria monocytogenes septicemia is seen predominantly in which patients?
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patients with depressed cell-mediated immunity
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What species is the major producer of enteric fevers?
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Salmonella typhi
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What are major risk factors for typhoid fever?
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• achlorhydria
• defects in cellular and humoral immunity • malnutrition • malignancy • sickle cell anemia |
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What is the treatment for typhoid fever?
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• 3rd generation cephalosporins
• fluoroquinolones |
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List some febrile syndomes associated with animal exposure
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• Brucellosis
• Leptospirosis • Q fever |
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What is the organism that causes Q fever and what is the treatment?
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• caused by Coxiella burnetii
• Tx: tetracycline (2g/day PO for 14 days) |
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What is the organism that causes Leptosirosis?
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Leptospira interrogans
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Describe the presentation of patients with leptospirosis
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• develops chills, high fever, headache, and myalgias
• biphasic course • during 2nd phase, fever is less prominent, but headache, myalgias are excruciated and nausa, vomiting, and abdominal pain become prominent |
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What is the most important manifestation of the second (or immune) phase of Leptospirosis?
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aseptic meningitis
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What is a useful early sign of Leptospirosis?
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suffusion of the bulbar conjunctivae with visible corkscrew vessels surrounding the limbus
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What is the treatment for Brucellosis?
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• Pen G 2.4-3.6 million U/day
OR • Tetracycline 2 g/day PO |
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What is the treatment for Histoplasmosis?
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• Amphotericin B
or • Itraconazole |
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What bacterial organism typically causes toxic shock syndrome?
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Staphylococcus aureus
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How do patients with toxic shock syndrome clinically present?
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• high fever, hypotension, nausea vomiting, severe watery diarrhea, and myalgias (with confusion and oliguria in severe cases)
• diffuse erythroderma (a sunburn-like rash) w/ erythematous mucosal surfaces • later, intense scaling and desquamation of the skin (particularly of the palms and soles) |
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What is the treatment of toxic shock syndrome?
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• Nafcillin
or • Vancomycin (if resistant to Nafcillin) |
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What are the 3 rickettsial disease that are endemic in the US?
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• Rocky Mountain Spotted Fever
• Q fever • murine typhus |
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What is the causative organism of Rocky Mountain Spotted Fever?
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• Rickettsia rickettsii
• transmitted from dogs (or small wild animals) to ticks to humans |
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What is the presentation of patients with Rocky Mountain Spotted Fever?
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• after 2-14 days: severe frontal headache, mchills, fever, myalgias, conjunctivits, cough, and SOB
• rash begins on the 3rd to 5th day as 1-4 mm erythematous macules on hands, wrists, feet, and ankles • rash can spread to the trunk and may become petechial • intracascular coagulaopathy develops in some severely ill patients |
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What is the treatment for RMSF?
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Doxycycline or Tetracycline
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What organism most frequently causes Human ehrlichiosis?
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Ehrlichia chaffeensis
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How can RMSF and Ehrlichiosis be differentiated clinically?
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• RMSF has an earlier, more, frequent, and more severe cutaneous manifestations
• Ehrlichiosis more commonly has pulmonary manifestations and decreasing leukocyte counts |
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What is the organism that causes Lyme disease?
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• caused by Borrelia burgdorferi
• transmitted by the tick Ixodes dammini |
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How do patients with Lyme disease present?
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• 3 days - 3 weeks after the tick bite, patients develop a febrile illness associated with:
- arthralgias - erythema chronicum migrans - headache - myalgias - stiff neck • several weeks later, neurologic manifestations develop - meningoencephalitis with cranial nerve involvement and peripheral radiculoneuropathy |
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What are some virus that can cause fever and a rash?
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• Coxsackievirus
• Echovirus • Epstein-Barr virus • Hepatitis B • Herpes simplex virus • HIV • Measles • Rubella • Varicella |
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How can you distinguish between CMV and EBV infection?
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• CMV tends to involve older patients and often produces milder disease
• CMV is less likely to cause pharyngitis • CMV often causes high fever with little to no peripheral adenopathy • CMV has less hematologic and neurologic involvement |
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What are the most frequently affected lymph nodes in Staph aureus or group A streptococcal infections?
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• submandibular
• cervical • inguinal • axillary * in order from most common to least common |
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Chronic regional lymphadenopathy after exposure to cats suggest what diagnosis?
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Cat-scratch disease (caused by Bartonella henselae)
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What is the classic cause of ulceroglandular fever?
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Tularemia (Francisella tularensis)
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How do patients with ulceroglandular fever present?
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• chills
• fever • painful regional adenopathy • ulcerated skin lesion at the site of inoculation |
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What is the treatment for Tularemia?
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streptomycin
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What are some diseases that can cause inguinal lymphadenopathy?
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• chancroid (unilateral, painful, and composed of fused lymph nodes)
• primary genital herpes simplex virus infection (tender lymphadenopathy) • primary syphillis (discrete, firm, non-tender) • lymphogranuloma venereum (causes matting of involved nodes and fixation to overlying skin which produces a purplish hue |
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What is fever of unknown origin?
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• applied to febrile illnesses with temperatures exceeding 101º F
• at least 3 weeks duration • remain undiagnosed after 3 days in the hospital or 3 outpatient visits |
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What are the different categories of FUO?
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• classic FUO: caused by infections, malignancy, inflammatory disease, and drugs
• nosocomial FUO • neutropenic FUO • HIV-associated FUO |
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What are some infectious causes of FUO?
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• endovascular infections
• intra-abdominal abscess • mycobacterial infections • osteomyelitis • perirenal or prostatic abscess • sinusitis • viral infections (CMV or EBV) |
