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[EDITED] YEAR 5: Chemical Pathology PM > 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

What are the categories of PUO under the Durack and Street criteria?

A
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3
Q

What are the causes of classic PUO?

A
  • Infection
  • Malignancy
  • Collagen vascular disease
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4
Q

What are the causes of nosocomial PUO?

A
  • C. difficile enterocolitis
  • Drug-induced
  • Pulmonary embolus
  • Septic thromboplebitis
  • Sinusitis
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5
Q

What are some causes of immune deficient (neutropenic) PUO?

A
  • Opportunistic bacterial infection
  • Fungi - aspergillosis, candidiasis
  • Herpes virus
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6
Q

What are some causes of HIV-associated PUO?

A
  • CMV
  • Mycobacterium avium-intracellulare complex
  • Pneumocystis carinii pneumonia
  • Drug-induced
  • Kaposi sarcoma
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7
Q

History points for PUO

A
  • B Symptoms (FLAWS), localising symptoms
  • Medications - doses & initiation date
  • Contact history - pets / animals
  • Drug use
  • Sexual history
  • Foreign travel
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8
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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9
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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10
Q

What investigations for PUO?

A

Any others - speak to consultant (money)

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11
Q

What is the first line test in diagnosis of acute EBV infection?

A

Serum EBV IgM

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12
Q

What imaging and tissue diagnositic techniques might you employ in PUO?

A

Imaging

  • FDG-PET (?cancer)
  • Echocardiogram

Tissue

  • Biopsy
  • LP
  • Bone marrow aspiration
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13
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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14
Q

Describe the Duke Criteria for infective endocarditis.
What is required for diagnosis?

A
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15
Q

What are some infective causes of PUO?

A
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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 e.g. Indian man, swimming in freshwater…

17
Q

What is the most common inflammatory cause of pyrexia?

A
  1. Adult-onset Still’s disease
  2. Giant Cell Arteritis (2nd most common)

Best way to rule these two out is a Ferritin (raised in Still’s) or ESR (raised in GCA)

18
Q

Describe the diagnostic criteria for Adult-onset Still’s disease

A
19
Q

List 2 clinical features of Adult-onset Still’s

A
  • Salmon pink rash - can be mistaken for drug-induced rash
  • Ferritin often very high in Adult-onset Still’s (macrophage activation syndrome)
20
Q

What are some clinical features of GCA?

A
  • Age > 50
  • Headache
  • Jaw claudication
  • 50% have vision changes
  • High risk of blindness/stroke
21
Q

How is GCA diagnosed and managed?

A

Diagnosis

  • Blood ESR > 45 (needs to be age adjusted)
  • Temporal artery biopsy (gold standard)

Managment

  • High-dose prednisolone immediately
  • Refer to rheumatology and opthalmology
22
Q

Malignant causes of PUO

A
  • Lymphoma (esp. non-Hodgkins) - raised LDH, weight loss, lymphadenopathy
  • Leukamia - bone marrow biopsy
  • Renal Cell Carcinoma - 20% present with fever, haematuria can occur
  • Hepatocellular carcinoma or liver metastases
23
Q

What are is the most common miscellaneous cause of PUO?

A

Drug-induced

  • 1/3 of hospitalised patients suffer form adverse drug reactions, including ‘drug fever’
  • This can be an idiosyncratic reaction or because the drug affects thermoregulation
  • Eosinophilia and rash accompany drug fever in 25%
24
Q

Conditions that require URGENT (preconfirmation) treatment

A
  • Infective endocarditis
  • Disseminated TB (FLAWS)
  • CNS TB (headache / reduced GCS)
  • GCA
  • SEPSIS
25
Q

Which causes of PUO should you think of when ferritin is very high?

A

Adult-onset Still’s disease

26
Q

How would you diagnose active TB?

A

Sputum culture - gold standard but slow

IGRA is not diagnostic of active TB

[EDITED] YEAR 5: Chemical Pathology PM (27 decks)

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