Faget's Sign & Liebermeister's Rule Pulse-Temperature Dissociation EVERY 1 F RISE IN TEMPERATURE -> HR INCREASES 8-10 BPM INFECTIOUS CAUSES • Legionella • Psittacosis • Q Fever • Typhoid Fever • Typhus • Babesiosis • Malaria • Leptospirosis • Yellow Fever • Viral Hemorrhagic Fevers • Rocky Mountain Spotted • Fever OTHER CAUSES • Beta Blockers • CNS Lesions • Lymphomas • Factitious Fever • Drug Fever CLINICAL UTILITY 1. Legionella 2. Chlamydia 3. Typhoid Fever (S. typhi) 4. Dengue Fever NOTE: There is limited predictive value in pulse-temperature dissociation and the most likely infection. However! There are specific cases where it can help hone your differential. #Fagets #Sign #Pulse #Temperature #Dissociation #diagnosis #differential #causes

Causes of Fever: IMADE Mnemonic INFECTION • Infection 1.0 - Common & Localizing: Base Rate • Infection 2.0 - Beyond The Base Rate: Tick-Borne. Fungal, TB, etc. MALIGNANCY • Leukemia & Lymphoma >> Solid Cancers +/- Hepatic Metastases • Pearl: 20% of renal cell carcinomas present with fever! AUTOIMMUNE • SLE • Adult-Onset Stills Disease • Schnitzler • GPA • Vasculitides • Myosites DRUGS • SJS-TEN: lamotrigine, valproate. carbamezapine, sulfa drugs, aminopenicillins. allopurinol, oxicam NSAlDs • DIHS: allopurinol. carbamezapine. lamotrigine. phenytoin. sulfasalzine. vancomycin, minocycline, dapsone. sulfamethoxazole • NMS: neuroleptics, antipsychotics • Others: antihistamines. amphetamines, hydralazine. methyldopa. antithyroids DVT/PE • Thrombosis leads to increased inflammtory cytockines (IL-I, IL-6, IL-8, TNF-alpha)! Heparin itself has anti-inflammatory properties. and avoid premature closure with DVT/PE + fever. ENDOCRINE • Most commonly associated with hyperthyroidism. Also think about subacute thyroiditis, adrenal insufficiency, or pheochromocytoma #Fever #IMADE #Mnemonic #Causes #IMADDE #diagnosis #differential

Strongyloides Stercoralis EPIDEMIOLOGY - ASSOCIATED WITH SOUTHEASTERN U.S.: • 0-6% US Prevalence of those: • ~30% Asymptomatic • Contracted through soil (walking with bare feet), human waste/sewage contact, farming CLINICAL FEATURES - 3 PHASES: - Invasion: larva currens (pruritus serpiginous urticarial tracks) primarily on lower abdominal wall, buttocks, thighs - Migration to Pulmonary System: cough, wheezing, shortness of breath, pulmonary infiltrates - Intestinal Manifestations & Autoinfection: Indigestion, abdominal pain, vomiting, diarrhea, steatorrhea, enteropathy, protein-calorie malnutrition, weight loss DIAGNOSIS • Identification of larvae in stool or duodenal fluid. • Hyperinfection: sputum, gastric aspirates • IgG ELISA TREATMENT • Ivermectin: 200mcg/kg/day for 2 days or • Albendazole: 400mg PO BID for 7 days PEARLS: • Can take several weeks after infection to be detected in the stool; intermittent egg excretion can lower diagnostic yield. ELISA and other assays approach 100% sensitivity and specificity • Look for Eosinophilia HYPERINFECTION SYNDROME: • Translocation through bowel wall can carry flora + Strongyloides into systemic circulation • GNR Bacteremia + Multiple Organ Involvement • Sudden generalized abdominal pain and distension, fever, petechia/purpura, cough, wheezing, hemoptysis #Strongyloides #Stercoralis #diagnosis #management #parasites #Threadworm #lifecycle

#Kawasaki #TSS #toxicshocksyndrome #KawasakiDisease #pediatrics #infographic #peds #diagnosis

Hypoxia vs Hypoxemia - Know the difference • Hypoxia - Underoxygenation of organs, tissues, and cells impairing normal metabolism • Hypoxemia - Low blood oxygen as measured by arterial and or venous oxygenation #hypoxia #hypoxemia #comparison #diagnosis #versus

Great Mimickers - SHALLOTS Mnemonic S- Syphilis - Neurosyphilis, aortitis, gummas... Granulomas can form anywhere! Skin, mucosa, joints, bones, lungs, testes, etc. H _ HIV - Hepatitis, dermatitis, dementia, anemia, thrombocytopenia, lymphoma Kaposi sarcoma What doesn't HIV cause? A - Amyloid - Amyloid deposits everywhere so it can manifest as anything L - Lupus - Fevers, rashes, edema, dyspnea, ulcers, arthritis, alopecia, Raynaud, pericarditis, pleuritis, drug-induced Head is spinning? Could be lupus in the ear or brain. L - Lymphoma - Fevers, weight loss, splenomegaly, cytopenias, nausea, vomiting, headaches, seizures, hypercalcemia„. firm lymph nodes anywhere and everywhere T - Tuberculosis - Not just consumption- number one cause of adrenalitis worldwide - granulomas anpvhere. Search lorganl tuberculosis and always have it in the back of your mind S - Sarcoidosis - Not just a cough, and also rashes, arthritis, hepatomegaly, myositis, xerostomia, hypopituitarism, splenomegaly, fatigue, and oh yeah all that lymphadenopathy #Mimickers #SHALLOTS #Mnemonic #Diagnosis #Differential #Mimics

#seizure #syncope #hypoglycemia #stroke