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37 Cards in this Set

  • Front
  • Back
What is the difference between fever and hyperthermia?
• 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
What are some causes of hyperthermia?
• CNS disorders (ex. paraplegia)
• heat stroke
• reactions to anesthetics (mallignant hyperthermia)
• reaction to phenothiazines (neuroleptic malignant syndrome)
• vigorous exercise
What are some characteristics of heat stroke?
• body temperature greater than 40.6º C (105º F)
• associated with coma and with cessation of sweating
Listeria monocytogenes septicemia is seen predominantly in which patients?
patients with depressed cell-mediated immunity
What species is the major producer of enteric fevers?
Salmonella typhi
What are major risk factors for typhoid fever?
• achlorhydria
• defects in cellular and humoral immunity
• malnutrition
• malignancy
• sickle cell anemia
What is the treatment for typhoid fever?
• 3rd generation cephalosporins
• fluoroquinolones
List some febrile syndomes associated with animal exposure
• Brucellosis
• Leptospirosis
• Q fever
What is the organism that causes Q fever and what is the treatment?
• caused by Coxiella burnetii
• Tx: tetracycline (2g/day PO for 14 days)
What is the organism that causes Leptosirosis?
Leptospira interrogans
Describe the presentation of patients with leptospirosis
• 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
What is the most important manifestation of the second (or immune) phase of Leptospirosis?
aseptic meningitis
What is a useful early sign of Leptospirosis?
suffusion of the bulbar conjunctivae with visible corkscrew vessels surrounding the limbus
What is the treatment for Brucellosis?
• Pen G 2.4-3.6 million U/day
• Tetracycline 2 g/day PO
What is the treatment for Histoplasmosis?
• Amphotericin B
• Itraconazole
What bacterial organism typically causes toxic shock syndrome?
Staphylococcus aureus
How do patients with toxic shock syndrome clinically present?
• 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)
What is the treatment of toxic shock syndrome?
• Nafcillin
• Vancomycin (if resistant to Nafcillin)
What are the 3 rickettsial disease that are endemic in the US?
• Rocky Mountain Spotted Fever
• Q fever
• murine typhus
What is the causative organism of Rocky Mountain Spotted Fever?
• Rickettsia rickettsii
• transmitted from dogs (or small wild animals) to ticks to humans
What is the presentation of patients with Rocky Mountain Spotted Fever?
• 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
What is the treatment for RMSF?
Doxycycline or Tetracycline
What organism most frequently causes Human ehrlichiosis?
Ehrlichia chaffeensis
How can RMSF and Ehrlichiosis be differentiated clinically?
• RMSF has an earlier, more, frequent, and more severe cutaneous manifestations
• Ehrlichiosis more commonly has pulmonary manifestations and decreasing leukocyte counts
What is the organism that causes Lyme disease?
• caused by Borrelia burgdorferi
• transmitted by the tick Ixodes dammini
How do patients with Lyme disease present?
• 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
What are some virus that can cause fever and a rash?
• Coxsackievirus
• Echovirus
• Epstein-Barr virus
• Hepatitis B
• Herpes simplex virus
• Measles
• Rubella
• Varicella
How can you distinguish between CMV and EBV infection?
• 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
What are the most frequently affected lymph nodes in Staph aureus or group A streptococcal infections?
• submandibular
• cervical
• inguinal
• axillary

* in order from most common to least common
Chronic regional lymphadenopathy after exposure to cats suggest what diagnosis?
Cat-scratch disease (caused by Bartonella henselae)
What is the classic cause of ulceroglandular fever?
Tularemia (Francisella tularensis)
How do patients with ulceroglandular fever present?
• chills
• fever
• painful regional adenopathy
• ulcerated skin lesion at the site of inoculation
What is the treatment for Tularemia?
What are some diseases that can cause inguinal lymphadenopathy?
• 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
What is fever of unknown origin?
• 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
What are the different categories of FUO?
• classic FUO: caused by infections, malignancy, inflammatory disease, and drugs
• nosocomial FUO
• neutropenic FUO
• HIV-associated FUO
What are some infectious causes of FUO?
• endovascular infections
• intra-abdominal abscess
• mycobacterial infections
• osteomyelitis
• perirenal or prostatic abscess
• sinusitis
• viral infections (CMV or EBV)