Medical Terminology on Edema and Fever
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Questions and Answers

Pitting edema occurs primarily in the upper extremities.

False (B)

Congestive heart failure can lead to peripheral edema in the legs and feet.

True (A)

Hypoalbuminemia is one of the causes of generalized edema.

True (A)

Orthopnea is characterized by difficulty breathing while lying down.

<p>True (A)</p> Signup and view all the answers

All forms of edema are classified as pitting edema.

<p>False (B)</p> Signup and view all the answers

Intermittent fever is characterized by a gradual rise in temperature followed by a prolonged afebrile period.

<p>False (B)</p> Signup and view all the answers

Recurrent fever features a regular pattern of high temperatures sustained for several days followed by a return to normal.

<p>True (A)</p> Signup and view all the answers

Undulant fever is another term for intermittent fever and is commonly associated with malaria.

<p>False (B)</p> Signup and view all the answers

Irregular fever refers to a consistent pattern of temperature that can be predicted easily.

<p>False (B)</p> Signup and view all the answers

The cause of alternate-day fever is linked to Plasmodium vivax and Plasmodium ovale.

<p>True (A)</p> Signup and view all the answers

Non-infectious fever can result from hyperthyroidism.

<p>True (A)</p> Signup and view all the answers

A very high fever is classified as a temperature above 41°C.

<p>True (A)</p> Signup and view all the answers

Remittent fever allows for normal temperature readings during the daily fluctuations.

<p>False (B)</p> Signup and view all the answers

Dehydration can contribute to the development of non-infectious fever.

<p>True (A)</p> Signup and view all the answers

A continued fever maintains temperatures below 39°C for extended periods.

<p>False (B)</p> Signup and view all the answers

Antigen antibody reactions are not associated with non-infectious fever.

<p>False (B)</p> Signup and view all the answers

Heat stroke is a physical cause of dysfunction in central heat regulation.

<p>True (A)</p> Signup and view all the answers

Extensive dermatitis can decrease the elimination of heat from the skin, contributing to non-infectious fever.

<p>True (A)</p> Signup and view all the answers

Breath with a garlic flavor can indicate organophosphorus poisoning.

<p>True (A)</p> Signup and view all the answers

Body temperature is generally highest in the early morning.

<p>False (B)</p> Signup and view all the answers

Sputum that has a stinky odor is associated with lung abscess or bronchiectasis.

<p>True (A)</p> Signup and view all the answers

The rectal temperature is typically lower than the oral temperature.

<p>False (B)</p> Signup and view all the answers

Fever is primarily defined as a body temperature exceeding 38°C.

<p>False (B)</p> Signup and view all the answers

Uremia is associated with ammonia odor in the breath.

<p>True (A)</p> Signup and view all the answers

The hypothalamus does not play a role in regulating body temperature.

<p>False (B)</p> Signup and view all the answers

Body temperature typically varies less than 2°C throughout the day.

<p>False (B)</p> Signup and view all the answers

Fever of Unknown Origin (FUO) is defined as a temperature of at least 39.1℃ for a duration of 3 weeks.

<p>False (B)</p> Signup and view all the answers

In Fever Case-1, the patient's associated symptoms included cough, sputum, and rigor.

<p>True (A)</p> Signup and view all the answers

Edema is caused solely by an increase in cellular fluid.

<p>False (B)</p> Signup and view all the answers

The total body water in a human body is composed of 2/3 intracellular space and 1/3 extracellular space.

<p>True (A)</p> Signup and view all the answers

In Fever Case-1, the patient's white blood cell count was 16.8 G/L, indicating a significantly elevated level.

<p>True (A)</p> Signup and view all the answers

The two basic reasons for edema include an increase in intracellular fluid volume.

<p>False (B)</p> Signup and view all the answers

In Fever Case-1, the patient displayed temperature fluctuations greater than 1°C daily.

<p>False (B)</p> Signup and view all the answers

Pneumonia is an infectious cause associated with Fever Case-1.

<p>True (A)</p> Signup and view all the answers

Malaria is associated with periodic pyrexia and a fever-free interval.

<p>False (B)</p> Signup and view all the answers

Rigor is associated with septicemia.

<p>True (A)</p> Signup and view all the answers

Conjunctival congestion is not associated with epidemic hemorrhagic fever.

<p>False (B)</p> Signup and view all the answers

Arthralgia can be a symptom of brucellosis.

<p>True (A)</p> Signup and view all the answers

Herpes is always associated with chronic febrile illnesses.

<p>False (B)</p> Signup and view all the answers

History taking involves reviewing systemic symptoms like cough and abdominal pain.

<p>True (A)</p> Signup and view all the answers

Scarlet fever is associated with mucocutaneous bleeding.

<p>False (B)</p> Signup and view all the answers

Typhus is not associated with rash as a symptom.

<p>False (B)</p> Signup and view all the answers

Flashcards

Generalized Edema

Swelling throughout the body, not localized to one area.

Congestive Heart Failure (CHF)

Heart condition causing fluid buildup, often in legs & feet. Can have left and right sided types affecting different parts of the body

Pitting Edema

Edema that leaves a dent (pit) when pressed.

Localized Edema

Swelling limited to a specific region of the body.

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CHF Symptoms

May include shortness of breath (dyspnea), swelling in the legs/feet, abnormal heart sounds (gallop rhythm), and fluid buildup in the lungs (pulmonary edema).

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Abnormal Body Odor

Unusual smells from the body, such as alcohol, garlic, rotten apples, ammonia, or fishy odors, that can indicate underlying medical conditions.

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Olfactory Diagnosis

Diagnosis of a medical condition by sensing and analyzing smells.

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Breath Smell - Alcohol

Moderate alcohol consumption may produce an alcohol-like breath smell in a patient.

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Breath Smell - Garlic

A breath odor resembling garlic may indicate organophosphorus poisoning.

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Body Temperature Regulation

The body maintains a stable core temperature (36-37°C) through biological mechanisms.

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Core Body Temperature

The internal temperature of the body, maintained within a narrow healthy range.

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Factors Affecting Body Temp

Age, gender, time of day, environment, and activity influence body temperature.

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Clinical Significance of Odor

Identifying abnormal body odors can aid in diagnosing certain conditions like infections, poisoning, or metabolic issues

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Intermittent Fever

Fever that rises abruptly, stays high for a while, then quickly returns to normal, followed by periods without fever.

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Recurrent Fever

Fever that spikes to high levels for several days, then suddenly drops to normal, followed by periods without fever, repeating the cycle.

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Undulant Fever

Fever that gradually rises and falls over a period of days, a pattern of repeated cycles.

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Irregular Fever

Fever with an unpredictable temperature curve.

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Alternate-day fever

Fever that occurs every other day.

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Non-infectious fever causes

Fever caused by factors other than infections, including injury, ischemia, cell necrosis, allergies, endocrine/metabolic issues, decreased heat elimination, and central/nervous system dysfunction.

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Fever Grades

Categorization of fever by temperature: low (37.3-38°C), middle (38.1-39°C), high (39.1-41°C), and very high (>41°C).

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Fever Onset

How fever starts; can be sudden (e.g., pneumonia) or gradual (e.g., typhoid).

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Fever Persistence

Extended fever lasting days or weeks.

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Remittent Fever

Fever with daily fluctuations exceeding 2°C and no normal temperatures.

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Continued Fever

Fever above 39-40°C for days/weeks, with minimal daily fluctuations (<1°C).

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Fever Patterns

Variations in temperature over time (e.g., remittent, continued) are often part of diagnosing.

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Fever Pattern Influence

Fever pattern might be changed by treatment (e.g., antibiotics, antipyretics) or patient response.

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Malaria Symptoms

Characterized by intermittent fever, chills, and sweating, potentially with rigors and a fever-free interval.

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Relapsing Fever Pattern

Recurring fever with periods without fever; usually lasting 3-6 days, followed by a week without fever.

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Periodic Pyrexia

A fever that fluctuates in cycles with variable intervals.

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Associated Symptoms (Rash)

Skin conditions like Scarlet Fever, Rubella, Chickenpox or Typhus can accompany fever.

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History Taking (Fever Onset)

Important to note: how suddenly, intensity, duration and frequency of the fever, predisposition factors.

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Systemic Symptoms (Fever)

Fever can be accompanied by cough, chest pain, abdominal pain, vomiting and diarrhea. Review of these symptoms is important.

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History Taking (Exposure)

Assess potential exposure events (water, infection, surgery) for evaluating fever onset and cause.

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Fever with Bleeding

Severe infections, acute infectious diseases, or hematological conditions may cause fever accompanied by bleeding.

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FUO (Fever of Unknown Origin)

Fever lasting at least 3 weeks, with a temperature of 38.3°C or higher, and no diagnosis after 1 week of inpatient investigation.

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Diagnostic points for Fever

Important factors to consider when diagnosing a fever, including other symptoms, duration, contact with others having similar illness, exposures, history of diseases, current medications and allergies.

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Edema

Excess fluid buildup in the interstitial spaces of the body.

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Pathogenesis of Edema

The process involving the increase of extracellular fluid volume and the disturbance of intravascular fluid balance.

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Fever Case-1 (Symptoms)

A 50-year-old male with a sudden onset of 3-day fever (39.1-39.5°C), accompanied by cough, sputum, rigor, and pallor.

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Fever Case-1 (Physical Findings)

Presenting with pallor of the skin and mucous membranes, moist crackles and reduced breath sounds and with body measurement (H160cm,W49kg, BP 100/60mmhg, HR 97bpm, R 30bpm).

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Fever Case-1 (Bloodwork – Infection)

Elevated white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) , indicating possible bacterial infection such as pneumonia.

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Fever Types

Different patterns of fever, including intermittent, remittent, sustained, and hectic.

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Study Notes

Diagnostics

  • Diagnostics is a discipline that applies basic theoretical knowledge, skills, and diagnostic thinking to patient care.

Types of Clinical Diagnosis

  • Etiological diagnosis: Based on causative factors, ideal for disease treatment and prevention.
  • Pathological diagnosis: Clarifies the location, characteristics, and micro-structural changes of a lesion.
  • Pathophysiological diagnosis: Highlights the functional changes in the body.
  • Symptomatic diagnosis: Identifies symptoms or signs with an undefined cause, requiring further clarification.

Diagnostic Principles

  • Explaining clinical manifestations: Attempt to link all observed clinical presentations to a single disease. If not possible, consider other diseases or complications.
  • Prioritizing common diseases: Begin by investigating common diseases first. Only after ruling out common conditions should rare diseases be considered. This requires significant supporting diagnostic evidence.
  • Suspecting organic diseases: If differentiating abnormalities is difficult, organic diseases should be considered more seriously than milder conditions.
  • Prioritizing curable diseases: During diagnosis, prioritize diseases with potential cures over those considered refractory or incurable.
  • Reconciling clinical and laboratory findings: If clinical findings disagree with laboratory results, investigate and verify the history taking or testing procedure. Correct misdiagnosis.

Contents

  • History Taking (Symptoms)
  • Physical examination (Signs)
  • Laboratory and Auxiliary examination
  • etc.

History Taking

General Data

  • Name
  • Sex
  • Age
  • Marital status
  • Occupation
  • Birthplace
  • Race
  • Home Address
  • Phone number
  • History Taker
  • Reliability
  • Date of admission

Chief Complaints

  • Main symptoms or signs
  • Characteristics
  • Duration (in concise sentences under 20 words)
  • Exclude diagnostic terms and diseases

Present Illness

  • Onset: When and how the problem started
  • Main symptoms and their features
  • Associated symptoms
  • Consultation and treatment (type, dosage, duration) and effectiveness
  • Problems caused by the condition

Past History

  • Previous illnesses (e.g., diabetes, hypertension, infections)
  • Hospitalizations (detail of conditions, dates, outcome)
  • Operations (types, dates, outcomes)
  • Major injuries
  • Allergies (food, drugs, contact substances)

Menstrual History

  • Age of menarche

Marital History

Childbearing History (Obstetric History)

  • Gravida, Para, Abortion (e.g., G3P1A2)

Family History

  • Health status of relatives and spouse

Systems Review

  • General health status & body weight
  • Mouth
  • Respiratory system & Cardiovascular
  • Digestive system
  • Urinary system
  • Hematopoietic system
  • Metabolic & Endocrine system
  • Musculoskeletal system
  • Nervous system

Physical Examination

  • Methods:

  • Visual inspection

  • Palpation

  • Percussion

  • Auscultation

  • Olfaction

  • Palpation: Examiner assesses local contact, body surface responses for abnormalities, especially in the abdomen. Techniques include light palpation, deep palpation, and deep pressure palpation.

  • Percussion: Tapping the body surface to assess vibrations, sounds, and organ characteristics (e.g., dullness for liver/heart, tympany for lungs.) Direct and indirect methods. Percussion sounds:

  • Voiceless - Normal lung

  • Dullness - Heart/Liver

  • Solid sound - Liver, Heart etc

  • Drum sound - Gastric bubble area and abdomen

  • Over voiceless - Emphysema

  • Auscultation: Listening to sounds from the body's parts (heart, lungs), evaluating normalcy, use of stethoscope. Direct and indirect method.

  • Smell: Detecting abnormal smells (e.g., alcohol, ketones, ammonia). Associate with specific diseases (e.g., ketoacidosis, uremia).

Laboratory and Auxiliary Examination

  • Examinations of body fluids, excreta, tissue/cell samples using physical, chemical, and biological methods.
  • Evaluates etiology, organ function, etc.
  • Auxiliary examinations use various instruments (e.g., ECG, lung function tests, endoscopy).

Fever

Body Temperature

  • Normal range: 36-37°C.
  • Varies with measurement method (rectal higher than oral, axillary lower than oral).
  • Influenced by factors: age, gender, time of day, ambient temperature, activity level, stress, pregnancy, etc.

Fever Pathophysiology

  • Tight hypothalamic regulation of core temperature.
  • Deviation of 4°C or more can cause severe cellular dysfunction.
  • Hypothalamus maintains a set-point for temperature.

Fever Definition

  • Elevation in core body temperature attributed to an upward resetting of the hypothalamic thermostatic set-point by pyrogens.

Fever Pathogenesis

  • Pyrogens cause an elevated thermostatic set-point.
  • Basal Metabolic Rate (BMR) increases by 10% (causes a 0.6°C rise in body temperature).

Fever Etiology and Classification

  • Infectious causes (viral, bacterial, etc.) are common.
  • Non-infectious causes (injury, autoimmune, chemical, etc.) also exist.

Infectious Fever

  • Caused by various pathogens (viruses, bacteria, mycoplasma, spirochetes, fungi, parasites).
  • Localized and systemic infections can induce fever.
  • Exogenous pyrogens stimulate endogenous pyrogen-generating cells to create endogenous pyrogens that cause fever.

Non-infectious Fever

  • Caused by various conditions, including absorption of necrotic substances, injuries, ischemic necrosis, cell necrosis, allergies, antibiotics, endocrine/metabolic disturbances (hyperthyroidism), dehydration, decreased heat elimination from skin, heart failure, extensive dermatitis, antigen-antibody reactions, rheumatic fever, serum disease, connective tissue diseases, central heat regulation dysfunction (heat stroke, chemical poisoning), vegetative nervous system dysfunction (sympathetic overactivity).

Clinical Manifestations

  • Fever grades: Low, middle, high, very high (temperatures)
  • Onset: Sudden, gradual
  • Persistence, pattern of fever.
  • Subsidence: Crisis, Lysis
  • Fever patterns (continued, remittent, intermittent, recurrent, undulant, irregular).

Associated symptoms:

  • Rigor
  • Rash
  • Mucocutaneous bleeding
  • Arthralgia
  • Conjunctival congestion
  • Herpes

History Taking and Fever

  • Onset (speed), duration, pattern (intermittent or persistent), factors influencing it (e.g., season). Associated factors: chills, sweating, night sweats.
  • Review of systems (cough, sputum, hemoptysis, chest, abdominal pain, vomiting, diarrhea, urinary frequency, urgency, rash, bleeding, headache, muscle pain).
  • General status (mental state, appetite, weight change, sleep, urination, defecation).
  • Detail info on previous treatment, especially antibiotics, antipyretics, corticosteroids, exposure to infectious diseases, contaminated water, surgical history, miscarriage or childbirth history).
  • Diagnostic points: other symptoms, duration & magnitude, contact with similar illness, occupational/travel/recreation exposure, history of diseases, current medication, allergies.

Fever of Unknown Origin (FUO)

  • Defined by Petersdorf and Beeson (1961).
  • Temperature ≥ 38.3°C repeatedly.
  • Duration ≥ 3 weeks.
  • No diagnosis after 1 week of inpatient investigation.

Edema

Definition

  • Edema is the pathological accumulation of excess fluid in the interstitial spaces.
  • Not associated with cellular edema.

Pathogenesis

  • Fluid distribution (intracellular vs. extracellular).
  • Extracellular space (intravascular plasma volume vs. extravascular interstitial space).
  • Two primary causes:
    • Increased extracellular fluid volume (excess fluid in interstitial spaces)
    • Imbalance in intravascular fluid exchange (more fluid leaving than entering interstitial spaces).

Classification

  • Generalized edema
    • Congestive heart failure
    • Nephrotic syndrome
    • Cirrhosis
    • Hypoalbuminemia
    • Drug-induced
    • Idiopathic
  • Localized edema
    • Local inflammation/allergy
    • Limb venous thrombosis
    • Inferior vena cava obstruction syndrome
  • Occurs in lower extremities.
  • Symmetric location.
  • Associated with heart disease.
  • Symptoms include: cardiac enlargement, gallop rhythm, dyspnea, basilar rales, venous distention, hepatomegaly.
  • Often starts in facial periorbital areas.
  • Rapid progression.
  • Associated with hypoalbuminemia, retention of sodium/water, hematuria, proteinuria, hypertension and impaired renal function tests.
  • Nephrotic syndrome results in decreased colloid oncotic pressure, causing fluid to shift into interstitial spaces.
  • Edema can occur in other parts, often due to hypoalbuminemia/increased intra-abdominal pressure impeding venous return from the lower extremities.

Idiopathic Edema

  • Cause is unknown.
  • Characterized by fluctuations in severity, often worsened by hot weather.
  • Potential cause: increased capillary permeability, reduced plasma volume, activation of the RAAS (renin-angiotensin-aldosterone system).

Drug-induced Edema

  • Various medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs), antihypertensives, calcium channel blockers, steroid hormones (corticosteroids, androgens, estrogens, progestins), growth hormone, immunotherapies, some antibodies (e.g., OKT3).

Other Causes of Edema

  • Hypothyroidism (myxedema)
  • Exogenous hyper-adrenocorticism
  • Pregnancy

Approach to Patients

  • Determine if edema is generalized or localized.
  • Evaluate possible causes (heart, liver, kidney, venous obstruction, lymphotic obstruction).

Associated Symptoms

  • Edema with symptoms like proteinuria, hematuria often linked to kidney diseases (e.g., nephrotic syndrome, diabetic nephropathy).
  • Edema with autoimmune diseases might also feature arthritis, skin changes, mild proteinuria in cardiogenic cases. Edema with dyspnea or cyanosis often indicates heart disease or superior vena cava syndrome.
  • Edema associated with menstrual cycles common in idiopathic cases.
  • Edema (in premenstrual tension syndrome) may present with insomnia, irritability, mental anxiety.

History Taking (Edema)

  • Time of edema onset, triggers, precursor symptoms.
  • Location and progression order, influencing factors like body position.
  • Speed of edema progression, edema characteristics (e.g., pitting), any signs of infections, allergic reactions, malnutrition.
  • Current treatments with adrenal cortical hormones, estrogen, or other drugs.
  • Accompanying symptoms (skin color/temperature, tenderness, rash, thickness), gastrointestinal symptoms (jaundice, bleeding), and urinary changes (color, frequency), hypertension and renal function.
  • Cough, expectoration, breathlessness (linked to heart/lung issues).
  • Appetite/weight change, cold sensitivity, constipation (linked to hypothyroidism).
  • Relationship between edema, menstruation, body position, and daytime/nighttime symptoms (specific for female patients).

Summary-Diagnosis

  • Excluding major organ dysfunction (heart, liver, kidneys).
  • Questioning patients about rings, belts, clothes getting tight.
  • Careful dietary & medication review (especially sodium, total fluid intake).
  • Physical examination of edema (location, symmetry, pitting/non-pitting, skin changes, tenderness).
  • Severity assessment (e.g., four-point scale).
  • Laboratory tests: chemistry panel, urinalysis (renal & liver function), albumin levels (nutritional status).
  • Thyroid function tests (thyrotropin).
  • ECG/chest x-ray if cardiac involvement is suspected.

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Description

This quiz covers essential medical terms related to edema and fever. It explores types of edema, causes, as well as different types of fever and their characteristics. Perfect for students in medical or healthcare courses.

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