Questions and Answers
What causes fever?
Auto-immune diseases, blood cancers, cancer, certain drugs (like Amphotericin B), endocrine disorders, familial Mediterranean fever, gastrointestinal issues, heart conditions, infections, miscellaneous causes, and neurological conditions.
What is malignant hyperthermia?
High fever due to succinylcholine, typically given in the operating room to relax the laryngeal muscle.
What is the treatment for fever?
Antimicrobials if a microbe is present, antipyretics, and treatment of the underlying condition.
What are the causes of non-infectious post-operative fever?
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What would prompt you to think that a post-op fever is infectious?
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What is the initial treatment for post-op fever in the absence of information about infection?
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What is the treatment for infectious post-op fever?
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What are the components of headache evaluation?
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What is the lab/diagnostic test and treatment for tension headaches?
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What is the pathophysiology behind migraine headaches?
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What are the physical exam findings you may find in a migraine headache?
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What labs/diagnostic tests do you order in patients with new migraine headaches?
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What is the management for a migraine headache?
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What is the management for an acute attack of a migraine headache?
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Cluster headaches affect mostly __________?
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What are the causes/incidence of cluster headaches?
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What can you do to reduce the rate of infection from bites, especially cat bites?
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Would you also consider x-rays as needed?
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Wounds to the hands or lower extremities should be left open.
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Plastic surgery consult may be appropriate.
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For human bites, employ a ___ to ___ day course for PO prophylactic antibiotics with coverage for both staphylococci and anaerobes.
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What are the common causes of cellulitis in the outpatient setting?
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What are the common causes of cellulitis in the inpatient setting?
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Study Notes
Fever Causes
- Auto-immune conditions: SLE, GCA
- Hematologic malignancies: leukemia, lymphoma
- Cancer as a broader category
- Drug-induced: Amphotericin B, certain beta-lactam antibiotics, procainamide
- Endocrine disorders: hyperthyroidism, pheochromocytoma
- Familial Mediterranean fever connection
- Gastrointestinal issues: intra-abdominal abscesses, inflammatory bowel disease
- Cardiac events: myocardial infarction, endocarditis
- Infections: bacterial, viral, fungal, parasitic
- Miscellaneous: hematoma
- Neurological factors: tumor, intracranial hemorrhage, multiple sclerosis that disrupt thermoregulation
Malignant Hyperthermia
- High fever caused by succinylcholine usage
- Commonly administered in the operating room to induce muscle relaxation
- Hyperkalemia is a contraindication for succinylcholine
- Treatment involves dantrolene to counteract succinylcholine effects
Fever Treatment
- Antimicrobials should only be given if a microbial infection is confirmed
- Antipyretics to reduce fever symptoms
- Address the underlying condition causing the fever
Non-Infectious Post-Operative Fever Causes
- Post-operative atelectasis or lung collapse
- Increased basic metabolic rate post-surgery
- Dehydration contributing to elevated temperature
- Drug reactions: Amphotericin B, trimethoprim-sulfamethoxazole, beta-lactam antibiotics, procainamide, isoniazid, alpha-methyldopa, quinidine
Infectious Indicators in Post-Operative Fever
- Symptomatic complaints typically suggest infectious causes, paired with elevated white blood cell counts indicating left shift (bandemia)
- White blood cell count exceeding 30,000 usually not due to infections
- Surgical incisions or invasive device placement can be infection entry points
- Common infectious sources: urinary tract infections, pneumonia, sinusitis, abscesses (especially intra-abdominal)
Initial Management of Post-Operative Fever
- Focus on hydration and measures to enhance lung function
Treatment for Infectious Post-Operative Fever
- Intravenous fluids and acetaminophen until further information is available
- Investigate the underlying infection source via gram stain and culture of all invasive devices
- Do not suppress inflammatory response prior to obtaining cultures for accurate results
Headache Evaluation Components
- Chronological history is crucial
- Assess location, duration, and quality of the headache
- Note associated activities (exertion, sleep, tension)
- Consider the timing relative to the menstrual cycle
- Identify any associated symptoms or identifiable triggers
Tension Headache Management
- No specific diagnostic lab tests available
- Over-the-counter analgesics and relaxation techniques are the cornerstone of treatment
Migraine Pathophysiology
- Linked to dilation and excessive pulsation of external carotid artery branches
- Lasts from 2 to 72 hours, often following trigeminal nerve pathways
Physical Exam Findings in Migraines
- Patients may appear normal or have mild neurological deficits
- Potential for visual disturbances, aphasia, numbness, nausea/vomiting, photophobia, and phonophobia
- Conduct a thorough neurological examination for focal deficits or signs of tumors
Diagnostic Tests for New Migraines
- Complete blood count and basic metabolic panel
- VDRL to rule out syphilis
- ESR may reveal elevated levels in conditions like Giant Cell Arteritis
- Head CT to exclude tumors or hemorrhage, especially in younger patients
Migraine Management
- Avoid known triggers; effective management includes relaxation strategies
- Prophylactic daily treatment for patients experiencing migraines more than 2-3 times a month, with options such as:
- Amitriptyline (Elavil)
- Divalproex (Depakote)
- Propranolol (Inderal)
Acute Migraine Attack Management
- Rest in a dark, quiet environment
- Immediate use of simple analgesics for partial relief
- Sumatriptan (Imitrex) may be administered subcutaneously with specific dosage guidelines
Cluster Headaches
- Commonly affect middle-aged men and are characterized by severe pain
- Often precipitated by alcohol; usually occurs nightly, interrupting sleep and lasting weeks
Management After Animal Bites
- Timely, thorough high-pressure irrigation with normal saline (NS) or lactated ringer's (LR) is essential for infection management
- Consider x-rays as necessary, particularly with facial and hand bites
- Wounds older than 6 hours typically should be left open for secondary intention healing
- Consultation with plastic surgery may be required for complex wounds
Antibiotic Guidelines for Bites
- For human and animal bites, a 3 to 7-day course of Augmentin (amoxicillin/clavulanate) is often recommended for prophylactic coverage against staphylococci and anaerobes
Cellulitis Common Pathogens
- Outpatient: Streptococcus pyogenes (group A strep) is the most common, with S. aureus being less common
- Inpatient: Gram-negative organisms like E. coli and Klebsiella, along with MRSA and classic Streptococcus are prevalent.
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Description
Explore the various causes of fever, including auto-immune conditions, infections, and drug-induced factors. This quiz also covers malignant hyperthermia and appropriate treatment options for fever. Test your knowledge on this critical medical topic!
