Causes of Fever of Unknown Source

Interactive Game!

Family Medicine Specialist CMEOctober 15-17, 2012Pakse

Fever of unknown source

Infections

Infections

Infections

Infections + Other

Other

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Topic 1: 200

•Question:•What disease, transmitted by day biting

mosquitos, presents with fever, headache, and diffuse whole body bone and muscle pain?

•Answer•Dengue Fever

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Topic 1: 400

•Question:•What disease, transmitted by a dawn and

dusk biting mosquito, classically presents with cyclic symptoms every 48 hours, of fevers, chills, sweats, headache, and muscle pain?

•Answer•MalariaBa

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Topic 1: 600

•Question:•Typical physical exam findings of a non-

itchy macular rash on the trunk, enlarged lymph nodes, enlargement of liver or spleen, and relative bradycardia suggest which infection?

•Answer•Scrub typhusBa

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Topic 1: 800

•Question:•A farmer presents with fever, vomiting,

bloody diarrhea and shortness of breath. On exam, he has redness and inflammation of the eyes, and petechiae and purpura over his body. Labs show renal and liver failure. Chest x-ray shows alveolar infiltrates. What does he likely have?

•Answer▫Leptospirosis

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Topic 1: 1000

•Question:•What are 5 risk factors for acquiring and

dying from melioidosis?

•Answer▫Diabetes▫Alcoholism▫Immunosuppression▫Renal failure▫Thalassemia

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Topic 2: 200

• Question:• This test is done by inflating a blood pressure cuff

between the patient’s systolic and diastolic pressure for 5 minutes. If the skin under the cuff has >20 petechiae in an area measuring 2.5cm x 2.5cm then the test is positive. What is the (a) name of this test and (b) if it is positive, what disease do you suspect?

• Answer▫ (a) Tourniquet test (b) Dengue hemorrhagic feverBa

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Topic 2: 400

•Question:•A patient presents with 6 weeks of fever,

night sweats, weight loss, and cough. What infection is most likely given the subacute presentation?

•Answer•Tuberculosis

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Topic 2: 600

•Question:•What are the 3 most common bacteria

that cause bacterial endocarditis?

•Answer▫a) Staphylococcus aureus▫b) Viridans group streptococci▫c) Enterococci

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Topic 2: 800

•Question:•Liver and spleen abscesses are common

complications of this disease, occurring in 25% of infected patients. It is therefore important to look for these abscesses with ultrasound, if available, even if patients are asymptomatic. What is this disease?

•Answer▫Melioidosis

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Topic 2: 1000•Question:• You see these findings when examining a febrile

patient: a) Non painful pink lesions to palms b) petechiae c) painful purple nodules on fingers d) splinter hemorrhages under nailbed. What disease does he have?

Answer Infective endocarditis

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Topic 3: 200

•Question:•A patient presents with an ulcer at the

site of a mite larvae bite, which has then become necrotic and formed an eschar. What disease does he have?

•Answer▫Scrub typhusBa

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Topic 3: 400

•Question:•What are the 2 most common species of

Plasmodium that cause malaria in Lao PDR. Which of the two causes much more severe disease?

•Answer•Plasmodium falciparum >> Plasmodium

vivax▫P. falciparum causes much more severe

disease

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Topic 3: 600

•Question:•How is leptospirosis transmitted?

•Answer•Through contact with soil or freshwater

that is contaminated by the urine of infected animal carriers (rats, cows, pigs, dogs, goats)

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Topic 3: 800

• Question:• What are 4 risk factors that increases the risk for

infective endocarditis?

• Answer▫1. Injection recreational drug use▫2. Structural heart disease (such as rheumatic

heart disease)▫3. Previous history of having infective endocarditis▫4. Invasive intravascular procedures or lines (such

as hemodialysis lines)Back

Topic 3: 1000

• Question:• These chest X-ray findings are all consistent with

which disease?

▫Answer▫Pulmonary tuberculosis(A. Upper lobe cavity B. Lymphadenopathy C. Infiltrates)

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Topic 4: 200

•Question:•What are the 2 most common types of

cancers that cause fever and often present with enlarged lymph nodes, night sweats, weight loss, and abnormal blood counts?

•Answer:•Leukemia and LymphomaBa

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Topic 4: 400

•Question:•What type of cancer presents not only

with fever, but also with hematuria and a flank mass?

•Answer•Renal Cell Carcinoma

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Topic 4: 600

•Question:•A farmer has been working in his field all

day. That night, he presents to the hospital with fever, flushing, lethargy, tachypnea, and tachycardia. What is the cause of his fever?

•Answer▫Heat strokeBa

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Topic 4: 800

•Question:• A 30 year old man has had 3 months of fever and

diffuse lymphadenopathy. His WBC is low. He has pain when swallowing, and his tongue has a white coating on it. 1) What underlying infection is causing the fever? 2) What is the white coating on his tongue?

•Answer• 1) HIV 2) Candidiasis (yeast)Ba

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Topic 4: 1000

•Question:•What laboratory abnormalities can you

see in someone with renal cell carcinoma?

•Answer• Polycythemia (high hematocrit and hemoglobin)• Hypercalcemia• High liver enzymes (even without liver

metastases)Back

Topic 5: 200

•Question:•What 2 autoimmune diseases are these

findings classic for (both of which can cause fever)?

a. b.

▫Answer a. Lupus b. Rheumatoid arthritis

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Topic 5: 400

•Question:•What is the most common autoimmune

disease to present with fever in older adults and also presents with jaw claudication, loss of vision, and often pain in the shoulders and hips?

•Answer•Giant cell (temporal) arteritisBa

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Topic 5: 600

•Question:•What disease occurs 2-4 weeks after

pharyngitis, and can present with arthritis, rash, subcutaneous nodules, carditis, chorea, and fever?

•Answer•Rheumatic fever

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Topic 5: 800

•Question:•A patient presents with fever, tachycardia,

tremor, anxiety, sweating. On exam, you see they have a stare and lid lag. What disease does this patient have?

•Answer•Hyperthyroidism

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Topic 5: 1000

•Question:•Drug fever can occur, usually in

hospitalized patients, but is a diagnosis of exclusion. What are 2 clues that may help you to suspect that the fever is from a drug reaction? (1 clinical finding, 1 laboratory finding)

•Answer•Rash and eosinophilia

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