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review CP > ChemPath: PUO > Flashcards

ChemPath: PUO Flashcards

1
Q

Defined criteria commonly accepted definition of PUO

A

Durack and Street criteria

  • Temperature >38.3
  • Duration >3weeks
  • Evaluation in at least 3 outpatient visits / 3 days hospital
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2
Q

Other Categories of PUO in Durack criteria

A

Nosocominal
Patient hospitalised >24 hrs but no fever on admission

Immune deficient
Neutrophil count <500 per mm^3

HIV associated

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3
Q

Common Nosocomial causes of PUO

A

C.Diff
Drug induced
Pulmonary embolus
Septic thromboplebitis
Sinusitis

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4
Q

HIV related causes of PUO

A

CMV
Mycobacterium avium-intracellulare complex
Pneumocystis carinii pneumonia
Kaposi sarcoma

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5
Q

History points for PUO

A
  • B Symptoms - FLAWS
  • Medications Doses & initiation date
  • Contact history - pets / animals
  • Drug use
  • Sexual history
  • Foreign Travel
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6
Q

Points to ask on Hx of Foreign Travel

A
  • Specific Village/ City?
  • What they did there
  • Where they stayed
  • Others infected
  • Walking barefoot?
  • Mosquito Nets
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7
Q

Test to consider in all PUO

A

HIV
(consent needed)

Exclude malaria in patient with tropical travel in last 2 years

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8
Q

Is an Interferon Gamma release assay (IGRA) useful in diagnosing TB

A

No

Doesnt tell you much for active TB

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9
Q

Routine Investigations for PUO

A

A&E
FBC
U&E
LFT
CRP
CXR
Blood Cultures
Urine Dip

Medic
2x Blood Cultures
Urine Culture
Stool Culture + OCP (Ova, cysts paracites)
CMV/EBV serology
HIV / HBV / HCV

CK
Ferritin
LDH
ANCA
ANA
RhF
TFT

Any others - speak to consultant (money)

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10
Q

Best scan for Cancer?

A

FDG-PET
(Fluorescently lablled Glucose - uptake and localisation of tumour)

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11
Q

When to order Echocardiogram in PUO

A

?Infective Endocarditis =
When the patient meets the Duke Criteria
2 major or [1 Major + 3 minor]

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12
Q

Major criteria of Duke Criteria

A

Persistent bacteraemia (>2 BC positive)
Echocardiogram: Vegetation
Positive Serology for bartonella, Coxiella or Brucella

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13
Q

Minor Criteria for Duke Criteria

A

Predisposition (murmur, IVDU)
Inflammatory Markers (Fever, CRP high)
Immune complexes (splinters / RBC in urine)
Embolic Phenomena (Janeway lesions, Olsers)
1 positive BC

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14
Q

Where is Schistosomiasis commonly found

A

Africa - along the Nile Delta

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15
Q

Infective Causes of PUO

A

Viral
CMV, EBV
HIV
Hepatitis ABCDE

Fungal
Cryptococcosis
Histoplasmosis

Paracites
Malaria
Amoebic LIver abcess
Schistosomiasis
Toxoplasmosis

Bacterial
Q Fever, Bartonella, Brucella
Mycobacteria - TB / NTM
Eneteric Fevers
Zoonoses

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16
Q

How to order tests for infective PUO

A

REFER TO RIPL
Rare and imported pathogens laboratory
Include discriminating characteristics - eg. INdian man, swiming in freshwater…

17
Q

Criteria for Adult onset stills disease

A

Major
Temp >39 for >1wk
Leukocytosis >10,000 /mm3
Typical Rash
Arthralgias >2weeks

Minor
Sore throat
Lymphadenopathy
Splenomeglay / Hepatomegaly
Abnormal LFTs (esp. AST, ALT, LDH ^^)
Neg ANA / Rf

18
Q

Typical Adult onset stills rash

A

Salmon Pink rash
(Can be mistaken for drug eruption / rash)

Ferritin oftern very high in Adult onset stills
(macrophage activation syndrome)

19
Q

Does Giant cell arteritis occur in Younger or older populaiton

A

Older
(almost never young ie. 20s 30s)

20
Q

Inflammatory causes of PUO

A

Vasculitis
CTD
GCA

(involve Rheumatologist early)

21
Q

Malignant causes of PUO

A
  • Lymphoma (esp. non hodgkins)
    Raised LDH, Weight Loss, Lymph nodes
  • Leukamia
    Bone marrow biopsy
  • Renal Cell Carinoma
    20% with Fever, (haematuria can occur)
  • Hepatocellular carcinoma or other tumor mets to liver
22
Q

Overall general subheadings for causes of PUO

A
  • Infective
  • Inflammatory
  • Malignant
23
Q

Indications for URGENT (preconfirmation) treatment

A
  • Infective endocarditis
  • Disseminated TB (FLAWS)
  • CNS TB (Headache / Reduced GCS)
  • GCA
  • SEPSIS
24
Q

Define Sepsis

A

Disordered Host repsonse to infection

25
Q

Define Septic Shock

A

End organ dysfunction / damage
due to sepsis

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