1. Causes of Fever of Unknown Source Interactive Game! Family Medicine Specialist CME October 15-17, 2012 Pakse

2. Fever of unknown source Infections Infections + Other Other 200 400 600 800 1000

3. 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

4. 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 Malaria

5. 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 typhus

6. 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

7. Topic 1: 1000 Question: What are 5 risk factors for acquiring and dying from melioidosis? Answer ▫Diabetes ▫Alcoholism ▫Immunosuppression ▫Renal failure ▫Thalassemia

8. 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 fever

9. 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

10. 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

11. 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

12. 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

13. 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 typhus

14. 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

15. 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)

16. 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)

17. 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)

18. 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 Lymphoma

19. 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

20. 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 stroke

21. 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)

22. 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)

23. Topic 5: 200 Question: What 2 autoimmune diseases are these findings classic for (both of which can cause fever)? a.b. ▫Answer  a. Lupusb. Rheumatoid arthritis

24. 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) arteritis

25. 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

26. 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

27. 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