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Questions and Answers
What defines hyperthermia?
What defines hyperthermia?
Which type of fever is indicated by a temperature that remains elevated throughout the day with less than 1 °C fluctuation?
Which type of fever is indicated by a temperature that remains elevated throughout the day with less than 1 °C fluctuation?
What pattern characterizes Pel-Ebstein fever?
What pattern characterizes Pel-Ebstein fever?
Which fever type refers to a temperature that returns to normal for days before rising again?
Which fever type refers to a temperature that returns to normal for days before rising again?
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Which symptom is commonly associated with fever but does not necessarily indicate an elevated body temperature?
Which symptom is commonly associated with fever but does not necessarily indicate an elevated body temperature?
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What symptom is most commonly associated with meningitis?
What symptom is most commonly associated with meningitis?
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Which factor is critical in evaluating a febrile patient?
Which factor is critical in evaluating a febrile patient?
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Which of the following is NOT a characteristic of rigors?
Which of the following is NOT a characteristic of rigors?
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Which infections are NOT typically associated with myalgia?
Which infections are NOT typically associated with myalgia?
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What type of fever pattern often requires inquiry about frequency?
What type of fever pattern often requires inquiry about frequency?
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Which symptom is strongly associated with upper respiratory tract infections?
Which symptom is strongly associated with upper respiratory tract infections?
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Which of the following symptoms is indicative of lymphoma and tuberculosis?
Which of the following symptoms is indicative of lymphoma and tuberculosis?
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What symptom is specifically associated with urinary tract infections?
What symptom is specifically associated with urinary tract infections?
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Which condition is most likely indicated by significant weight loss and abdominal pain?
Which condition is most likely indicated by significant weight loss and abdominal pain?
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Fleeting arthritis is a symptom most commonly associated with which condition?
Fleeting arthritis is a symptom most commonly associated with which condition?
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What is a significant size for lymph nodes in the cervical region to warrant further investigation?
What is a significant size for lymph nodes in the cervical region to warrant further investigation?
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What are common causes of generalized lymphadenopathy?
What are common causes of generalized lymphadenopathy?
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Which symptom is NOT typically associated with constitutional symptoms?
Which symptom is NOT typically associated with constitutional symptoms?
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What type of joint involvement is typically seen in infective causes like dengue and chikungunya?
What type of joint involvement is typically seen in infective causes like dengue and chikungunya?
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Which of the following combinations of symptoms is suggestive of pelvic inflammatory disease (PID)?
Which of the following combinations of symptoms is suggestive of pelvic inflammatory disease (PID)?
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When assessing abdominal symptoms, which condition is least likely indicated by diarrhea?
When assessing abdominal symptoms, which condition is least likely indicated by diarrhea?
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Which medical condition is NOT mentioned as part of the contextual history in relation to fever?
Which medical condition is NOT mentioned as part of the contextual history in relation to fever?
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What symptom might indicate the presence of endocarditis during examination?
What symptom might indicate the presence of endocarditis during examination?
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Which of the following factors is NOT part of the personal and social history relevant to fever?
Which of the following factors is NOT part of the personal and social history relevant to fever?
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Which condition is associated with hyperthermia accompanied by tachypnea and cough, especially noted during the Coronavirus Pandemic?
Which condition is associated with hyperthermia accompanied by tachypnea and cough, especially noted during the Coronavirus Pandemic?
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Which of the following findings in the oropharynx suggests an infectious etiology?
Which of the following findings in the oropharynx suggests an infectious etiology?
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The presence of altered mental function in a febrile patient may indicate which serious conditions?
The presence of altered mental function in a febrile patient may indicate which serious conditions?
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What should be examined regularly in a febrile patient?
What should be examined regularly in a febrile patient?
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Which of the following should raise concern for septic shock in a febrile patient?
Which of the following should raise concern for septic shock in a febrile patient?
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Which herb or alternative medicine is listed as a part of the drug history in relation to fever?
Which herb or alternative medicine is listed as a part of the drug history in relation to fever?
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Study Notes
Approach to Fever and Heat Disorders
- Hyperthermia: A rapid increase in core body temperature above 40°C due to the body producing or absorbing more heat than it dissipates.
- Hyperpyrexia: An extremely high fever, greater than 41.5°C, often seen with central nervous system (CNS) hemorrhages or severe infections.
- Hypothermia: A dangerously low body temperature, can signal an overwhelming infection and should be carefully evaluated.
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Fever Patterns: Different patterns of fever can offer clues toward the diagnosis:
- Continuous/Sustained Fever: Temperature remains above normal throughout the day and fluctuates less than 1°C within 24 hours. Examples include lobar pneumonia, typhoid, UTI, and brucellosis.
- Remittent Fever: Temperature stays above normal throughout the day, but fluctuates more than 1°C within 24 hours. Infective endocarditis is an example.
- Intermittent Fever: Temperature elevation occurs only for certain periods during the day, alternating with periods of normal temperature. Examples include pyemia and septicemia.
- Relapsing Fever: Temperature returns to normal for periods before rising again, with a pattern of periodic fever. This can be seen with specific malaria types.
- Pel-Ebstein Fever: A pattern of fever alternating between high and low periods, often associated with Hodgkin's lymphoma.
Presentation of Fever
- Feeling Hot: A feeling of heat is not always an indicator of fever, often accompanied by shivering chills and rapid temperature rise.
- Rigors: Severe shivering, teeth chattering, rapid temperature increase.
- Excessive Sweating: Night sweats are typical in some conditions such as tuberculosis.
- Headache: A common symptom that might indicate meningitis if severe.
- Delirium: Mental confusion that might be seen in extreme ages during fever.
- Muscle Pain: Myalgia is characteristic of viral infections, malaria and brucellosis.
Symptom Analysis for Fever
- Verification of Fever: Crucial to verify if the fever is genuine.
- Fever Duration: Acute or Chronic.
- Mode of Onset: Abrupt or Gradual
- Progression: Continuous or Intermittent
- Severity: How much the fever impacts daily activities.
- Relieving and Aggravating Factors: Note factors that cause the fever to worsen or improve.
- Associated Symptoms: Any other symptoms may be helpful to indicate the source of fever.
Pattern of Temperature Changes
- Various fever patterns are discussed and associated with possible diseases and conditions.
Chills and Rigors
- Profound chills accompanied by shivering and teeth chattering are common indicators of issues like malaria, sepsis, or infections.
Night Sweats
- A common symptom found in conditions such as lymphoma and tuberculosis
Headaches and Delirium
- Headache during fever may indicate more severe conditions such as meningitis.
Muscle Pain
- Muscle aches such as myalgias often occur with conditions involving infections.
Respiratory Tract Symptoms
- Sneezing, sore throat, purulent discharge suggest upper respiratory tract infection.
- Pain, headache, or respiratory distress indicate sinusitis or lower respiratory infections.
Genitourinary Symptoms
- Increased urination frequency or burning sensation may point toward urinary tract infections.
Abdominal Symptoms
- Abdominal pain and/or diarrhea can indicate gastrointestinal issues or abdominal infections
Joint Symptoms
- The nature and number of joints involved during the fever is important in diagnosing conditions.
Constitutional Symptoms
- Weakness, anorexia, weight loss, and night sweats often observed in more extensive infections and conditions.
Fever with Generalized Lymphadenopathy
- Important to examine all lymph nodes.
- Enlargement and tenderness can signify severe conditions like TB or lymphoma, beyond localized infection.
Contextual History
- Important medical history, past surgeries or transfusions, medications, including allergies, and previous infections can help point to relevant factors.
Examination Details
- Skin, Eyes, Throat, Nail beds, lymph nodes, abdomen and heart: Examinations focus on identifying specific signs and symptoms that could be indicative of severe conditions.
- Blood Pressure and its Variations: Hypotension could suggest potentially life-threatening infections.
- Mental Status Alterations: Any alterations to mental status in a febrile patient suggest potentially serious underlying conditions.
- Mouth and Oropharynx: Lesions or exudates in the mouth may indicate specific infectious causes.
Laboratory Investigations
- CBC with differential: This should be done for evaluating patients.
- Urine Analysis, Blood Films, Bone Marrow Aspiration, Stool Studies, Sputum Studies (gram stain/ZN staining): These studies can identify bacteria, parasites, fungal infections and other conditions.
- Chest X-rays: Important for evaluating the chest and lungs, when fever is unexplained.
- Abdominal X-rays: Often helpful to diagnose possible abdominal conditions, such as free air or fluid, when abdomen pain might be associated with fever.
Treatment
- General Measures: Fluids are key. Consider discontinuation of potentially fever-inducing medications.
- Empiric Antibiotic Therapy: In cases of suspected severe infection, empiric antibiotic treatment may be required and need to be narrowed once etiology is apparent, in patients with critical illness and suspected meningeal infection, and in immunocompromised patients or those with critical illness.
- Antipyretic Therapy: Medications to lower fever such as acetaminophen and ibuprofen may be helpful for controlling fever.
- Hospitalization may be necessary in certain situations based on the patient's needs and the potential severity of the condition.
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Description
Explore the critical aspects of fever and heat disorders, including hyperthermia, hyperpyrexia, and hypothermia. Understand various fever patterns and their implications for diagnosis. This quiz provides valuable insights into the management and evaluation of patients experiencing heat-related conditions.
