Answer:

No, there is no pathognomonic degree of fever that has been clearly associated with a specific risk of infection in patients, although before the widespread use of the Haemophilus influenzae vaccine, temperatures greater than 41.1°C were associated with a higher incidence of serious bacterial illness. In pediatrics medical decision making, the temperature should be used as only one piece of information in conjunction with many other factors.

Reference:  Baraff LJ: Fever without a source in infants and children. Ann Emerg Med Dec 36:6, 2000.

Answer:

Trust mothers–they know. Depending on the study, mothers are accurate in assessing the presence or absence of a fever 50% to 80% of the time. They seem to be more accurate at detecting when the child is febrile than they are at determining that the child is afebrile. Most pediatricians believe that fevers reported by mothers are probably real and need to be taken seriously. With a measured home fever, 84% of children spike a temperature within 24 hours, even when  afebrile in the emergency room.

Reference: Graneto JW, Soglin DF: Maternal screening of childhood fever by palpation. Pediatr Emerg Care 12:183-184, 1996.

Answer:

Yes. Rectal temperatures are the most accurate representation of core temperatures. Oral, axillary, and tympanic temperatures have considerable variation, and these methods are frequency used and often inaccurate. There is not a correction factor for these alternate modalities to provide a reliable assessment of the core temperature.

Reference: Loveys AA, Dutko-Fioravanti 1, Everly SW, et al: Comparison of ear to rectal temperature measurements in infants and toddlers. Clin Pediatr (Phila) 38:463-466, 1999

Answer:

We all wish we only had to remember one number; however, it varies depending on the patient:
1. In infants, 38°C (100.4°F) rectally constitutes a fever.
2. In adults, a temperature of 38.3°C (100.9°F) is a fever.
3. Certain patient populations may be exceptions, and this should be taken into account (e.g., elderly, IV drug users, and immunocompromised patients).
4. A temperature of 41.5°C (106.7°F) usually represents hyperthermia and not a true fever.

Reference: Loveys AA, Dutko-Fioravanti 1, Everly SW, et al: Comparison of ear to rectal temperature measurements in infants and toddlers. Clin Pediatr (Phila) 38:463-466, 1999

Answer:

Today, many investigators believe that fever is beneficial in fighting disease. Decades ago, before the discovery of antibiotics, experimentation revealed that syphilis could be cured by inducing fevers by infecting a patient with malaria. (Although successful, unless you want a letter from a lawyer, you probably shouldn’t use this form of treatment.) Higher temperatures increase the activity of neutrophils and lymphocytes and decrease the levels of serum iron, a substrate that many bacteria need to reproduce. Other studies indicate that fever may be detrimental in patients with tetanus, streptococci, and pneumococci.

Reference: Baker MD, Fosarelli PD, Carpenter RO: Childhood fever: Correlation of diagnosis with temperature response to acetaminophen. Pediatrics 80:315-318, 1987

Answer:

A true fever is an increase in core temperature caused by elevation of the hypothalamic setpoint. This causes the body to attempt to generate heat (e.g., by shivering) to elevate the body’s core temperature. In contrast, hyperthermia results in an elevated temperature without altering the set-point, so the body attempts to cool itseff to achieve a normal temperature. Some examples of hyperthemia include heatstroke, hyperthyroidism, bums, and malignant hyperthermia.

Reference:  Crocetti M, Moghbeli N, Serwint I: Fever phobia revisited: Have parental misconceptions about fever changed in 20 years? Pediatrics 107:1241-1246, 2001.

Answer:

For bony or soft tissue metastases in patients with estrogen or progesterone receptor-positive breast cancer, hormonal agents such as tamoxifen, anastrozole, letrozole, exemestane, or luteinizing hormone-releasing hormone agonists (in premenopausal women) can be used for effective palliation lasting many months. Newer drugs that target growth factor pathways in breast cancer are currently in development.

Reference:

• National Cancer Database: http://www.facs.org/cancer/ncdb/index.html
• National Guideline Clearinghouse: http://www.guideline.gov/
• PDQ Cancer Information Summaries: http://www.cancer.gov/
• SEER Cancer Statistics Review, 1975-2000: http://seer.cancer.gov/csr/1975_2000/